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Sample records for supernumerary phantom limb

  1. Atypical supernumerary phantom limb and phantom limb pain in two patients with pontine hemorrhage.

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    Yoo, Seung Don; Kim, Dong Hwan; Jeong, Yong Seol; Chon, Jinmann; Bark, Jihea

    2011-06-01

    Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.

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

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    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.

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

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    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.

  4. 幻肢和余剩幻肢研究的历史性回顾及新病例报告%The phantom and the supernumerary phantom limb: historical review and new case

    Institute of Scientific and Technical Information of China (English)

    Gabriele Cipriani; Lucia Picchi; Marcella Vedovello; Angelo Nuti; Mario Di Fiorino

    2011-01-01

    大脑通常决定人类对其周围环境的感受.幻肢是接受过截肢手术的人所产生的一种幻觉,他们总感觉失去的肢体仍存在于躯干上.揭开幻肢的成因已成为神经病学领域的一个研究热点.此外,一些病人中风后会感觉到除正常存在的双臂和双腿之外,还存在额外的肢体.这种复杂的、意识和知觉上的偏差称为余剩幻肢.本文主要就幻肢和余剩幻肢的病因及对其认识的历史性发展作一综述,并报告一例余剩幻肢患者.%The way we experience the world is determined by the way our brain works.The phantom limb phenomenon,which is a delusional belief of the presence of a non-existent limb,has a particular fascination in neurology.This positive phenomenon of the phantom limb raises theoretical questions about its nature.After a stroke,some patients experience the perception of an extra limb in addition to the regular set of two arms and two legs.This complex cognitive and perceptual distortion is called supernumerary phantom limb.Here,we review the pathogenesis and historical aspects,and report a new case.

  5. 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 ...

  6. [Phantom limb pain].

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    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.

  7. [Therapy of phantom limb pain].

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    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.

  8. 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...

  9. 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.

  10. The phantom limb in dreams.

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    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.

  11. 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

  12. Phantom limb pain after lower limb trauma: origins and treatments.

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    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.

  13. Phantom limb pain and related disorders.

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    Weinstein, S M

    1998-11-01

    Postamputation phenomena, including painful and nonpainful phantom sensations occur following loss of limbs and other body parts. Peripheral and central nervous system mechanisms play a role in persistent phantom pain. Understanding the pathophysiology of this syndrome has improved in recent years. Comprehensive evaluation and a multimodality treatment approach comprise the current standard of care of the patient with phantom pain.

  14. Phantom limb after stroke: an underreported phenomenon.

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    Antoniello, Daniel; Kluger, Benzi M; Sahlein, Daniel H; Heilman, Kenneth M

    2010-10-01

    The presence of a phantom limb (PL) resulting from a cerebral lesion has been reported to be a rare event. No prior study, however, has systematically investigated the prevalence of this syndrome in a group of post-stroke individuals. Fifty post-stroke individuals were examined with structured interview/questionnaire to establish the presence and perceptual characteristics of PLs. We document the presence of phantom experiences in over half of these individuals (n=27). We provide details of these phantom experiences and further characterize these symptoms in terms of temporal qualities, posture, kinesthesia, and associated features. Twenty-two participants reported postural phantoms, which were perceived as illusions of limb position that commonly manifested while lying in bed at night - a time when visual input is removed from multi-sensory integration. Fourteen participants reported kinesthetic phantoms, with illusory movements ranging from simple single joint sensations to complex goal-directed phantom movements. A striking syndrome of near total volitional control of phantom movements was reported in four participants who had immobile plegic hands. Reduplicative phantom percepts were reported by only one participant. Similarly, phantom pain was present in only one individual - the sole participant with a pre-stroke limb amputation. The results suggest that stroke results in phantom experiences more commonly than previously described in the literature. We speculate that subtotal deafferance or defective motor efference after stroke may manifest intermittently as a PL.

  15. Acupuncture treatment of phantom limb pain and phantom limb sensation in a primary care setting.

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    Davies, Arwel

    2013-03-01

    A 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within the constraints of a busy general medical practice.

  16. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Bishnu Subedi

    2011-01-01

    Full Text Available The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

  17. Pharmacological interventions for phantom limb pain

    Institute of Scientific and Technical Information of China (English)

    FANG Jun; LIAN Yan-hong; XIE Kang-jie; CAI Shu-nü

    2013-01-01

    Objective To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain.Data sources Both Chinese and English language literatures were searched using MEDLINE (1982-2011),Pubmed (1982-2011) and the Index of Chinese Language Literature (1982-2011).Study selection Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected.Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review.Results By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain,including anticonvulsants,antidepressants,local anaesthetics,N-methyl-D-aspartate receptor antagonists,non-steroidal anti-inflammatory drugs,tramadol,opioids,calcitonin,capsaicin,beta-adrenergic blockers,clonidine,muscle relaxants,and emerging drugs,we examined the efficacy and safety of these medications,outlined the limitations and future directions.Conclusions Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain,we recommend tricyclic antidepressants,gabapentin,tramadol,opioids,local anaesthetics and N-methyl-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.

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

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    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.

  19. Can neural blocks prevent phantom limb pain?

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    Borghi, Battista; D'Addabbo, Marco; Borghi, Raffaele

    2014-07-01

    Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. Nerve blocks have been investigated for the treatment and prevention of PLS. Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain.

  20. [Phantom limb pain. Psychological treatment strategies].

    Science.gov (United States)

    Diers, M; Flor, H

    2013-04-01

    Similar to other pain syndromes phantom limb pain is characterized by learning and memory processes that maintain the pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom limb pain but also reverse the associated maladaptive brain changes.

  1. Motor control over the phantom limb in above-elbow amputees and its relationship with phantom limb pain.

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    Gagné, M; Reilly, K T; Hétu, S; Mercier, C

    2009-08-04

    Recent evidence shows that the primary motor cortex continues to send motor commands when amputees execute phantom movements. These commands are retargeted toward the remaining stump muscles as a result of motor system reorganization. As amputation-induced reorganization in the primary motor cortex has been associated with phantom limb pain we hypothesized that the motor control of the phantom limb would differ between amputees with and without phantom limb pain. Eight above-elbow amputees with or without pain were included in the study. They were asked to produce cyclic movements with their phantom limb (hand, wrist, and elbow movements) while simultaneously reproducing the same movement with the intact limb. The time needed to complete a movement cycle and its amplitude were derived from the kinematics of the intact limb. Electromyographic (EMG) activity from different stump muscles and from the homologous muscles on the intact side was recorded. Different EMG patterns were recorded in the stump muscles depending on the movement produced, showing that different phantom movements are associated with distinct motor commands. Phantom limb pain was associated with some aspects of phantom limb motor control. The time needed to complete a full cycle of a phantom movement was systematically shorter in subjects without phantom limb pain. Also, the amount of EMG modulation recorded in a stump muscle during a phantom hand movement was positively correlated with the intensity of phantom limb pain. Since phantom hand movement-related EMG patterns in above-elbow stump muscles can be considered as a marker of motor system reorganization, this result indirectly supports the hypothesis that amputation-induced plasticity is associated with phantom limb pain severity. The discordance between the (amputated) hand motor command and the feedback from above-elbow muscles might partially explain why subjects exhibiting large EMG modulation during phantom hand movement have more phantom

  2. Phantom limb pain: a nursing perspective.

    Science.gov (United States)

    Virani, Anila; Green, Theresa; Turin, Tanvir C

    2014-09-09

    Phantom limb pain (PLP) is a neuropathic pain condition occurring after amputation of a limb. PLP affects amputees' quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions.

  3. Phantom limb pain from spinal sarcoma: a case report.

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    Cruz, Ernesto; Dangaria, Harsh T

    2013-07-01

    Phantom limb pain is a frequent sequela of amputation. A high prevalence of residual limb pain and back pain also exists among amputees. We present a case of a new-onset severe phantom limb pain resulting from a metastatic spinal mass in an 81-year-old patient with a history of malignant sarcoma and an old hip disarticulation amputation. The metastatic lesion, upon imaging, was found to involve the L3 vertebra and caused moderate compression of the thecal sac on the right and severe right lateral recess stenosis. After the mass was resected, the patient's phantom limb pain resolved. Our case report demonstrates that spinal metastatic pathologies may be a cause of phantom limb pain and should be included in the differential diagnosis of new-onset phantom limb pain or a change in phantom limb pain.

  4. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study

    OpenAIRE

    Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; Van Der Schans, CP

    2000-01-01

    Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time elapsed since the amputation. The purposes of this study were to determine prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Addition...

  5. Usefulness of milnacipran in treating phantom limb pain

    Directory of Open Access Journals (Sweden)

    Matsumoto Y

    2012-11-01

    Full Text Available Yasuhide Nagoshi,1 Akira Watanabe,1 Saiko Inoue,1 Tomoki Kuroda,2 Mitsuo Nakamura,3 Yoshitake Matsumoto,4 Kenji Fukui31Department of Psychiatry (Psychosomatic Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan; 2Gojouyama Hospital, Nara, Japan; 3Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 4Matsumoto Clinic, Kyoto, JapanBackground: Amputation of an extremity often results in the sensation of a “phantom limb” where the patient feels that the limb that has been amputated is still present. This is frequently accompanied by “phantom limb pain”. We report here the use of milnacipran, a serotonin and norepinephrine reuptake inhibitor, to treat phantom limb pain after amputation of injured or diseased limbs in three patients.Methods and results: The severity of phantom pain before and during treatment was quantified using a visual analog scale. In one case, phantom limb pain responded partially to treatment with high doses of paroxetine, and then replacement with milnacipran further improved the pain relief and long-term full pain relief was achieved. In the two other cases, milnacipran was used as first-line treatment and phantom limb pain responded rapidly.Conclusion: These results suggest that milnacipran administration may be useful in phantom limb pain, possibly as a first-line treatment.Keywords: milnacipran, paroxetine, phantom limb pain, selective serotonin reuptake inhibitor (SSRI, serotonin and norepinephrine reuptake inhibitor (SNRI

  6. Doctors Try Brain-Training to Curb 'Phantom Limb Pain'

    Science.gov (United States)

    ... with the study. "The problem with having a prosthetic limb is that when you try to control that hand, it does not translate. You use other parts ... needed for a patient to move their "phantom" hand, and linked those signals to a robot prosthetic limb. Patients experienced an increase in phantom pain ...

  7. 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…

  8. 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…

  9. Phantom pain and phantom sensations in upper limb amputees : an epidemiological study

    NARCIS (Netherlands)

    Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; van der Schans, CP

    2000-01-01

    Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time elap

  10. [Psychotherapies for the Treatment of Phantom Limb Pain].

    Science.gov (United States)

    Cárdenas, Katherine; Aranda, Mariana

    The phantom limb pain has been described as a condition in which patients experience a feeling of itching, spasm or pain in a limb or body part that has been previously amputated. Such pain can be induced by a conflict between the representation of the visual and proprioceptive feedback of the previously healthy limb. The phantom limb pain occurs in at least 42 to 90% of amputees. Regular drug treatment of phantom limb pain is almost never effective. A systematic review of the literature was conducted in Medline and Cochrane using the MESH terms "phantom limb pain" and "psychotherapy", published in the last 10 years, in English and Spanish, finding 49 items. After reviewing the abstracts, 25 articles were excluded for not being related to the objective of the research. Additionally cross references of included articles and literature were reviewed. To describe the psychotherapies used in the management of phantom limb pain, their effectiveness and clinical application reported in the literature. The mechanisms underlying phantom limb pain were initially explained, as were the published studies on the usefulness of some psychotherapies such as mirror visual feedback and immersive virtual reality, visual imagery, desensitization and reprocessing eye movements and hypnosis. The phantom limb pain is a complex syndrome that requires pharmacological and psychotherapeutic intervention. The psychotherapies that have been used the most as adjuvants in the treatment of phantom limb pain are mirror visual feedback, desensitization and reprocessing eye movements, imagery and hypnosis. Studies with more representative samples, specifically randomized trials are required. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  11. [Mirror therapy for phantom limb pain--a systematic review].

    Science.gov (United States)

    Seidel, Stefan; Kasprian, Gregor; Sycha, Thomas; Auff, Eduard

    2009-01-01

    The aim of this review was to evaluate the evidence for the treatment of phantom limb pain with mirror therapy. Randomised controlled studies were identified by a systematic search strategy in the databases "Medline" and "The Cochrane Library". The studies were evaluated using the quality criteria of the JADAD-scale. Three small-sized randomised controlled studies were identified. Unfortunately, these studies lacked methodological quality. One of them found a significant decrease of phantom pain after four weeks of daily mirror therapy sessions. Two other studies could not find a significant difference in the reduction of phantom limb pain between intervention- and control-groups. To date, there is only circumstantial evidence for mirror therapy in phantom pain. Hence, no firm recommendations regarding this treatment option are possible. More sufficiently powered randomised controlled studies with high methodological quality are mandatory to investigate the analgesic effect of mirror therapy in phantom limb pain.

  12. Capturing the Perceived Phantom Limb through Virtual Reality

    Directory of Open Access Journals (Sweden)

    Christian Rogers

    2016-01-01

    Full Text Available Phantom limb is the sensation amputees may feel when the missing limb is still attached to the body and is still moving as it would if it still existed. Despite there being between 50 and 80% of amputees who report neuropathic pain, also known as phantom limb pain (PLP, there is still little understanding of why PLP occurs. There are no fully effective long-term treatments available. One of the struggles with PLP is the difficulty for amputees to describe the sensations of their phantom limbs. The sensations may be of a limb that is in a position that is impossible for a normal limb to attain. The goal of this project was to treat those with PLP by developing a system to communicate the sensations those with PLP were experiencing accurately and easily through various hand positions using a model arm with a user friendly interface. The system was developed with Maya 3D animation software, the Leap Motion input device, and the Unity game engine. The 3D modeled arm was designed to mimic the phantom sensation being able to go beyond normal joint extensions of regular arms. The purpose in doing so was to obtain a true 3D visualization of the phantom limb.

  13. [Mirror, mirror of the wall: mirror therapy in the treatment of phantom limbs and phantom limb pain].

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    Casale, Roberto; Furnari, Anna; Lamberti, Raul Coelho; Kouloulas, Efthimios; Hagenberg, Annegret; Mallik, Maryam

    2015-01-01

    Phantom limb and phantom limb pain control are pivotal points in the sequence of intervention to bring the amputee to functional autonomy. The alterations of perception and sensation, the pain of the residual limb and the phantom limb are therefore aspects of amputation that should be taken into account in the "prise en charge" of these patients. Within the more advanced physical therapies to control phantom and phantom limb pain there is the use of mirrors (mirror therapy). This article willfocus on its use and on the possible side effects induced by the lack of patient selection and a conflict of body schema restoration through mirror therapy with concurrent prosthetic training and trauma acceptance. Advice on the need to select patients before treatment decisions, with regard to their psychological as well as clinical profile (including time since amputation and clinical setting), and the need to be aware of the possible adverse effects matching different and somehow conflicting therapeutic approaches, are put forward. Thus a coordinated sequence of diagnostic, prognostic and therapeutic procedures carried out by an interdisciplinary rehabilitation team that works globally on all patients' problems is fundamental in the management of amputees and phantom limb pain. Further studies and the development of a multidisciplinary network to study this and other applications of mirror therapy are needed.

  14. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb

    DEFF Research Database (Denmark)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal

    2016-01-01

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation...... of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support...... are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring...

  15. A Clinical Evaluation of Postamputation Phenomena Including Phantom Limb Pain after Lower Limb Amputation in Dysvascular Patients.

    Science.gov (United States)

    Richardson, Cliff; Crawford, Kath; Milnes, Karen; Bouch, Elizabeth; Kulkarni, Jai

    2015-08-01

    To explore the effects of phantom phenomena on a group of dysvascular lower limb amputees. This was a cross-sectional study of dysvascular lower limb amputees. A modified version of the phantom phenomena questionnaire was used to measure the prevalence of phantom phenomena and the effects of those phenomena on daily life. Eighty-nine amputees were recruited. The majority were inpatients (72%) and male (72%). Most had pain before amputation (83%). Sixty-three percent had phantom limb pain. No associations were found between phantom limb pain and preamputation pain (p = .397). Phantom limb pain was present immediately on waking from amputation in 23%. Phantom limb pain is highly fluctuant. It is more likely that phantom limb pain was present with more time passed since amputation (p = .002). Outpatients with unhealed wounds were less likely to have phantom limb pain (p = .007). The effects of postamputation phenomena include sleep loss and social restrictions. These results challenge the belief that phantom limb pain reduces over time as more outpatients reported phantom limb pain than inpatients. Preamputation pain is not linked to the presence of phantom limb pain. The fluctuant nature of phantom limb pain makes its treatment complex. Some may wish intensity to reduce, whereas others may prefer to reduce the number of episodes or duration of each episode instead. More research is needed to clarify the needs of amputees in relation to the postamputation phenomena.

  16. Incorporation of another person's limb into body image relieves phantom limb pain: a case study.

    Science.gov (United States)

    Weeks, Sharon R; Tsao, Jack W

    2010-12-01

    Phantom limb phenomena are well characterized, but the underlying mechanisms remain unclear. Here we report a patient who relieves his phantom sensations and pain, experienced as itching and cramping, through scratching or massaging his prosthesis or the leg of another person. This pain relief occurs only when phantom limb sensations are present. We hypothesize that symptom relief results from incorporation of the foreign limb into the patient's body image, mediated by the sensory mirror neuron system, relieving pain by restoring concordance between sensory systems.

  17. Design and development of a telerehabilitation platform for patients with phantom limb pain

    NARCIS (Netherlands)

    Andreas Rothgangel; Susy Braun; Rob Smeets; Anna Beurskens

    2017-01-01

    Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately,

  18. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb.

  19. Development of Phantom Limb Pain after Femoral Nerve Block

    Directory of Open Access Journals (Sweden)

    Sadiah Siddiqui

    2014-01-01

    Full Text Available Historically, phantom limb pain (PLP develops in 50–80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment.

  20. Suggested guidelines for treatment of phantom limb pain.

    Science.gov (United States)

    Sherman, R A; Tippens, J K

    1982-12-01

    Eighty to ninety percent of amputees have been shown to suffer significant amounts of phantom limb pain in contrast to the widely accepted level of about 5%. Surveys of the literature, of physicians actively treating phantom pain, and of over 3,000 American veteran amputees have shown that most of the usual treatments are not efficacious when followups of a year or more are done. A diagnostic and therapeutic schemata is presented, which incorporates the above surveys, research, and clinical experience into a unified approach optimizing the few treatments showing a reasonable hope of long term success. Every effort is made to identify the source of pain being referred into the phantom. Stump, back, prosthetic, and other physical problems are corrected prior to initiation of other treatments, including EMG or temperature feedback from the stump, sympathetic system alteration, modulation of anxiety and depression, TENS, and ultrasound. Key indexing terms: phantom pain, treatment, amputees, referred pain. Copyright 2013, SLACK Incorporated.

  1. Somatic and movement inductions phantom limb in non-amputees

    Science.gov (United States)

    Casas, D. M.; Gentiletti, G. G.; Braidot, A. A.

    2016-04-01

    The illusion of the mirror box is a tool for phantom limb pain treatment; this article proposes the induction of phantom limb syndrome on non-amputees upper limb, with a neurological trick of the mirror box. With two study situations: a) Somatic Induction is a test of the literature reports qualitatively, and novel proposal b) Motor Induction, which is an objective report by recording surface EEG. There are 3 cases proposed for Motor illusion, for which grasped movement is used: 1) Control: movement is made, 2) illusion: the mirror box is used, and 3) Imagination: no movement is executed; the subject only imagines its execution. Three different tasks are registered for each one of them (left hand, right hand, and both of them). In 64% of the subjects for somatic experience, a clear response to the illusion was observed. In the experience of motor illusion, cortical activation is detected in both hemispheres of the primary motor cortex during the illusion, where the hidden hand remains motionless. These preliminary findings in phantom limb on non-amputees can be a tool for neuro-rehabilitation and neuro-prosthesis control training.

  2. Early and effective use of ketamine for treatment of phantom limb pain

    Directory of Open Access Journals (Sweden)

    Harsha Shanthanna

    2010-01-01

    Full Text Available Treatment for phantom limb pain is difficult and challenging. There is often suboptimum treatment with fewer than 10% receiving lasting relief. Treatments based broadly on other neuropathic pains may not be appropriate for a clinical success. We report a case of phantom limb pain, which proved resistant to multiple analgesics, including opioids and continuous epidural blockade. Treatment with intravenous (IV ketamine as an alternate day infusion, gave complete remission of phantom limb pain. This demonstrates an early and effective use of a potent NMDA antagonist for treatment of phantom limb pain. Mechanisms underlying phantom limb pain are briefly discussed.

  3. Induced sensorimotor brain plasticity controls pain in phantom limb patients

    Science.gov (United States)

    Yanagisawa, Takufumi; Fukuma, Ryohei; Seymour, Ben; Hosomi, Koichi; Kishima, Haruhiko; Shimizu, Takeshi; Yokoi, Hiroshi; Hirata, Masayuki; Yoshimine, Toshiki; Kamitani, Yukiyasu; Saitoh, Youichi

    2016-01-01

    The cause of pain in a phantom limb after partial or complete deafferentation is an important problem. A popular but increasingly controversial theory is that it results from maladaptive reorganization of the sensorimotor cortex, suggesting that experimental induction of further reorganization should affect the pain, especially if it results in functional restoration. Here we use a brain–machine interface (BMI) based on real-time magnetoencephalography signals to reconstruct affected hand movements with a robotic hand. BMI training induces significant plasticity in the sensorimotor cortex, manifested as improved discriminability of movement information and enhanced prosthetic control. Contrary to our expectation that functional restoration would reduce pain, the BMI training with the phantom hand intensifies the pain. In contrast, BMI training designed to dissociate the prosthetic and phantom hands actually reduces pain. These results reveal a functional relevance between sensorimotor cortical plasticity and pain, and may provide a novel treatment with BMI neurofeedback. PMID:27807349

  4. 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.

  5. Peripheral nervous system origin of phantom limb pain.

    Science.gov (United States)

    Vaso, Apostol; Adahan, Haim-Moshe; Gjika, Artan; Zahaj, Skerdi; Zhurda, Tefik; Vyshka, Gentian; Devor, Marshall

    2014-07-01

    Nearly all amputees continue to feel their missing limb as if it still existed, and many experience chronic phantom limb pain (PLP). What is the origin of these sensations? There is currently a broad consensus among investigators that PLP is a top-down phenomenon, triggered by loss of sensory input and caused by maladaptive cortical plasticity. We tested the alternative hypothesis that PLP is primarily a bottom-up process, due not to the loss of input but rather to exaggerated input, generated ectopically in axotomized primary afferent neurons in the dorsal root ganglia (DRGs) that used to innervate the limb. In 31 amputees, the local anesthetic lidocaine was applied intrathecally and/or to the DRG surface (intraforaminal epidural block). This rapidly and reversibly extinguished PLP and also nonpainful phantom limb sensation (npPLS). Control injections were ineffective. For intraforaminal block, the effect was topographically appropriate. The suppression of PLP and npPLS could also be demonstrated using dilute lidocaine concentrations that are sufficient to suppress DRG ectopia but not to block the propagation of impulses generated further distally in the nerve. PLP is driven primarily by activity generated within the DRG. We recommend the DRG as a target for treatment of PLP and perhaps also other types of regional neuropathic pain.

  6. Motor cortex changes after amputation are modulated by phantom limb motor control rather than pain

    DEFF Research Database (Denmark)

    Raffin, Estelle E.; Pascal, Giraux,; Karen, Reilly,

    retains a residual M1-c activity when amputees perform phantom limb movements (4-5). Except a correlation between phantom limb pain and M1-c expansion of the face (2-3), the relationship between the ability to voluntary move the phantom hand, the level of phantom limb pain, the degree of M1-c......Amputation of a limb induces reorganization within the contralateral primary motor cortex (M1-c) (1-3). In the case of hand amputation, M1-c areas evoking movements in the face and the remaining part of the upper-limb expand toward the hand area. Despite this expansion, the amputated hand still...

  7. Phantom hand and wrist movements in upper limb amputees are slow but naturally controlled movements.

    Science.gov (United States)

    De Graaf, J B; Jarrassé, N; Nicol, C; Touillet, A; Coyle, T; Maynard, L; Martinet, N; Paysant, J

    2016-01-15

    After limb amputation, patients often wake up with a vivid perception of the presence of the missing limb, called "phantom limb". Phantom limbs have mostly been studied with respect to pain sensation. But patients can experience many other phantom sensations, including voluntary movements. The goal of the present study was to quantify phantom movement kinematics and relate these to intact limb kinematics and to the time elapsed since amputation. Six upper arm and two forearm amputees with various delays since amputation (6months to 32years) performed phantom finger, hand and wrist movements at self-chosen comfortable velocities. The kinematics of the phantom movements was indirectly obtained via the intact limb that synchronously mimicked the phantom limb movements, using a Cyberglove® for measuring finger movements and an inertial measurement unit for wrist movements. Results show that the execution of phantom movements is perceived as "natural" but effortful. The types of phantom movements that can be performed are variable between the patients but they could all perform thumb flexion/extension and global hand opening/closure. Finger extension movements appeared to be 24% faster than finger flexion movements. Neither the number of types of phantom movements that can be executed nor the kinematic characteristics were related to the elapsed time since amputation, highlighting the persistence of post-amputation neural adaptation. We hypothesize that the perceived slowness of phantom movements is related to altered proprioceptive feedback that cannot be recalibrated by lack of visual feedback during phantom movement execution.

  8. Maladaptive plasticity: imprinting of past experiences onto phantom limb schemata.

    Science.gov (United States)

    Giummarra, Melita Joy; Georgiou-Karistianis, Nellie; Nicholls, Michael E R; Gibson, Stephen J; Chou, Michael; Bradshaw, John L

    2011-10-01

    Phantom limb perception is common following amputation, and is sometimes characterised by pain that resembles the characteristics, intensity or location of past pain. We tested Flor's model that phantom pain results from memory for long-lasting znoxious input. We report a questionnaire study of 283 amputees, that explored the experience of painful, non-painful and postural somatosensory memories in the phantom. We explore the impact of pre-amputation pain and impairment duration, and complications in the limb (eg, infection, gangrene, surgery, and vascular disease). Differences in mood, coping and adjustment to amputation are also explored in those with somatosensory pain memories. Our findings support Flor's model, as amputation-related and non-amputation-related pain memories, and non-painful memories comprised pains or sensations that were either enduring/recurring pains or sensations (eg, ingrown toenail, corns, chilblains, arthritis-type pain in winter, night-cramps, or holding a tennis racquet), or resulted from a painful event with a "core-trauma" element (eg, fracture, crushing/penetration injury). Pain memories related to amputation were more common following functional impairment before amputation; infection or surgery prior to amputation; or having diabetic or vascular amputations-which are associated with multiple complications, including neuropathic changes, infection and prior surgery. Furthermore, participants with amputation-related pain memories exhibited higher sensory pain ratings, as well as poorer mood and adjustment to the limitations of amputation. We propose that somatosensory pain memories likely relate to the generation and maintenance of limb representations upon which intense or emotionally powerful past experiences have been imprinted.

  9. Phantom limb pain as a manifestation of paclitaxel neurotoxicity.

    Science.gov (United States)

    Khattab, J; Terebelo, H R; Dabas, B

    2000-07-01

    Paclitaxel is a chemotherapeutic agent with activity directed against several malignancies. It has multiple adverse effects including neurotoxicity. We describe 2 patients with prior amputation who experienced phantom limb pain (PLP) after receiving paclitaxel therapy. A third patient experienced disabling neurotoxicity in the extremity of a prior ulnar nerve and tendon transposition after receiving paclitaxel. This unique syndrome should be identified as a direct causal effect of paclitaxel. In this report, we review the pathophysiology of PLP and treatment options. Physicians should be aware that PLP can occur after initiation of paclitaxel.

  10. Phantom limb pain: an energy/trauma model.

    Science.gov (United States)

    Leskowitz, Eric

    2014-01-01

    Phantom limb pain (PLP) is a form of chronic neuropathic pain that responds poorly to treatment interventions derived from the neuroanatomic understanding of pain and analgesia. Several new psychological and behavioral treatments that have proven more effective have been explained by invoking neural plasticity as their mechanism of action. Other novel treatments that are based on an "energy medicine" model also appear to be quite effective, especially when addressing the psychological trauma of the amputation itself, a factor that is generally overlooked in the standard surgical approach to limb amputation. A speculative trauma/energy model for the etiology of PLP is proposed. This model is developed in some detail, and its utility in explaining several anomalous aspects of PLP, as well as the clinical efficacy of energy therapies, is outlined. This model is proposed as a step in the development of simple and effective energy/trauma treatment protocols for this widespread and largely treatment-resistant disorder.

  11. Psychophysical Evaluation of the Capability for Phantom Limb Movement in Forearm Amputees.

    Science.gov (United States)

    Kawashima, Noritaka; Mita, Tomoki

    2016-01-01

    A phantom limb is the sensation that an amputated limb is still attached to the body and is moving together with other body parts. Phantom limb phenomenon is often described on the basis of the patient's subjective sense, for example as represented using a visual analog scale (VAS). The aim of this study was to propose a novel quantification method for behavioral aspect of phantom limb by psychophysics. Twelve unilateral forearm amputees were asked to perform phantom wrist motion with various motion frequencies (60, 80, 100, 120, 140, 160, 180, 200, 220, 240% of preferred speed). The attainment of phantom limb motion in each session was rated by the VAS ranging from 0 (hard) to 10 (easy). The relationship between the VAS and motion frequency was mathematically fitted by quadric function, and the value of shift and the degree of steepness were obtained as evaluation variables for the phantom limb movement. In order to test whether the proposed method can reasonably quantify the characteristics of phantom limb motion, we compared the variables among three different phantom limb movement conditions: (1) unilateral (phantom only), (2) bimanual, and (3) bimanual wrist movement with mirror reflection-induced visual feedback (MVF). While VAS rating showed a larger extent of inter- and intra-subject variability, the relationship of the VAS in response to motion frequency could be fitted by quadric curve, and the obtained parameters based on quadric function well characterize task-dependent changes in phantom limb movement. The present results suggest the potential usefulness of psychophysical evaluation as a validate assessment tool of phantom limb condition.

  12. Psychophysical Evaluation of the Capability for Phantom Limb Movement in Forearm Amputees.

    Directory of Open Access Journals (Sweden)

    Noritaka Kawashima

    Full Text Available A phantom limb is the sensation that an amputated limb is still attached to the body and is moving together with other body parts. Phantom limb phenomenon is often described on the basis of the patient's subjective sense, for example as represented using a visual analog scale (VAS. The aim of this study was to propose a novel quantification method for behavioral aspect of phantom limb by psychophysics. Twelve unilateral forearm amputees were asked to perform phantom wrist motion with various motion frequencies (60, 80, 100, 120, 140, 160, 180, 200, 220, 240% of preferred speed. The attainment of phantom limb motion in each session was rated by the VAS ranging from 0 (hard to 10 (easy. The relationship between the VAS and motion frequency was mathematically fitted by quadric function, and the value of shift and the degree of steepness were obtained as evaluation variables for the phantom limb movement. In order to test whether the proposed method can reasonably quantify the characteristics of phantom limb motion, we compared the variables among three different phantom limb movement conditions: (1 unilateral (phantom only, (2 bimanual, and (3 bimanual wrist movement with mirror reflection-induced visual feedback (MVF. While VAS rating showed a larger extent of inter- and intra-subject variability, the relationship of the VAS in response to motion frequency could be fitted by quadric curve, and the obtained parameters based on quadric function well characterize task-dependent changes in phantom limb movement. The present results suggest the potential usefulness of psychophysical evaluation as a validate assessment tool of phantom limb condition.

  13. Phantom limb pain: a review of the literature on attributes and potential mechanisms.

    Science.gov (United States)

    Hill, A

    1999-02-01

    This study presents a review of the literature on the attributes and potential mechanisms involved in phantom limb pain, encompassing studies describing pain in the residual limb, phantom sensation and phantom limb pain, and the difficulties that may arise when making these distinctions. A variety of theories have been proposed to explain causal mechanisms for phantom limb pain. Conceptually, research into phantom limb pain is informed by the particular theory of chronic pain that is dominant at the time the research is undertaken. For example, early physiological theories on the etiology of phantom limb pain were grounded in specificity or pattern theories of pain. Later physiological research was based on the framework provided by Gate Control Theory and focused on identifying peripheral, spinal, and central neural mechanisms. Psychological explanations were grounded in psychoanalytic or personality theories of chronic pain which propose that phantom limb pain results from pre-amputation psychological disturbance. Despite numerous studies examining phantom limb pain, much of this research has both conceptual and methodological shortcomings. As such, the application of these research findings to clinical practice has limited utility.

  14. Factors associated with phantom limb pain : a 31/2-year prospective study

    NARCIS (Netherlands)

    Bosmans, J.C.; Geertzen, J.H.B.; Post, W.J.; van der Schans, C.P.; Dijkstra, P.U.

    2010-01-01

    Objective: To analyse the prevalence of phantom (limb) pain over time and to analyse factors associated with phantom (limb) pain in a prospective cohort of amputees. Design: A multicentre longitudinal study. Patients: One hundred and thirty-four patients scheduled for amputation were included. Metho

  15. Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Serra, Raffaele; Risitano, Claudia; Giardina, Massimiliano; Acri, Ignazio Eduardo; Volpe, Pietro; David, Antonio

    2016-04-01

    Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale.

  16. Design and development of a telerehabilitation platform for patients with phantom limb pain : a user-centered approach

    NARCIS (Netherlands)

    Rothgangel, Andreas; Braun, Susy; Smeets, Rob; Beurskens, Anna

    2017-01-01

    Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately,

  17. Etiology of phantom limb syndrome: Insights from a 3D default space consciousness model.

    Science.gov (United States)

    Jerath, Ravinder; Crawford, Molly W; Jensen, Mike

    2015-08-01

    In this article, we examine phantom limb syndrome to gain insights into how the brain functions as the mind and how consciousness arises. We further explore our previously proposed consciousness model in which consciousness and body schema arise when information from throughout the body is processed by corticothalamic feedback loops and integrated by the thalamus. The parietal lobe spatially maps visual and non-visual information and the thalamus integrates and recreates this processed sensory information within a three-dimensional space termed the "3D default space." We propose that phantom limb syndrome and phantom limb pain arise when the afferent signaling from the amputated limb is lost but the neural circuits remain intact. In addition, integration of conflicting sensory information within the default 3D space and the loss of inhibitory afferent feedback to efferent motor activity from the amputated limb may underlie phantom limb pain.

  18. Gray matter changes following limb amputation with high and low intensities of phantom limb pain.

    Science.gov (United States)

    Preissler, Sandra; Feiler, Johanna; Dietrich, Caroline; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2013-05-01

    Limb amputation and chronic phantom limb pain (PLP) are both associated with neural alterations at all levels of the neuraxis. We investigated gray matter volume of 21 upper limb amputees and 14 healthy control subjects. Results demonstrate that amputation is associated with reduced gray matter in areas in the motor cortex representing the amputated limb. Additionally, patients show an increase in gray matter in brain regions that belong to the dorsal and ventral visual stream. We subdivided the patient group into patients with medium to high PLP (HPLP; N = 11) and those with slight PLP (SPLP; N = 10). HPLP patients showed reduced gray matter in brain areas involved in pain processing. SPLP patients showed a significant gray matter increase in regions of the visual stream. Results indicate that all patients may have an enhanced need for visual control to compensate the lack of sensory feedback of the missing limb. As we found these alterations primarily in the SPLP patient group, successful compensation may have an impact on PLP development. Therefore, we hypothesize that visual adaptation mechanisms may compensate for the lack of sensorimotor feedback and may therefore function as a protection mechanism against high PLP development.

  19. Phantom Limb Pain: Low Frequency Repetitive Transcranial Magnetic Stimulation in Unaffected Hemisphere

    Directory of Open Access Journals (Sweden)

    Andrea Di Rollo

    2011-01-01

    Full Text Available Phantom limb pain is very common after limb amputation and is often difficult to treat. The motor cortex stimulation is a valid treatment for deafferentation pain that does not respond to conventional pain treatment, with relief for 50% to 70% of patients. This treatment is invasive as it uses implanted epidural electrodes. Cortical stimulation can be performed noninvasively by repetitive transcranial magnetic stimulation (rTMS. The stimulation of the hemisphere that isn't involved in phantom limb (unaffected hemisphere, remains unexplored. We report a case of phantom limb pain treated with 1 Hz rTMS stimulation over motor cortex in unaffected hemisphere. This stimulation produces a relevant clinical improvement of phantom limb pain; however, further studies are necessary to determine the efficacy of the method and the stimulation parameters.

  20. Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report

    Directory of Open Access Journals (Sweden)

    Yan Kun

    2011-01-01

    Full Text Available Abstract Introduction Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain. Case presentation We present the case of a 24-year-old Caucasian man, a left upper limb amputee, treated with mirror visual feedback combined with auditory feedback with improved pain relief. Conclusion This case may suggest that auditory feedback might enhance the effectiveness of mirror visual feedback and serve as a valuable addition to the complex multi-sensory processing of body perception in patients who are amputees.

  1. Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients.

    Science.gov (United States)

    Vase, Lene; Nikolajsen, Lone; Christensen, Bente; Egsgaard, Line Lindhart; Arendt-Nielsen, Lars; Svensson, Peter; Staehelin Jensen, Troels

    2011-01-01

    Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients' level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick). Catastrophizing accounted for 35% of the variance in phantom limb pain (p=0.001) independently of anxiety and depression. Catastrophizing was also positively associated with wind-up-like pain in non-medicated patients (p=0.015), but not to pain thresholds. These findings suggest that cognitive-emotional sensitization contributes to the altered nociceptive processing seen in phantom limb pain patients. The possible interactions between pain catastrophizing, wind-up-like pain, and peripheral input in generating and maintaining phantom limb pain are discussed.

  2. Pulling telescoped phantoms out of the stump: Manipulating the perceived position of phantom limbs using a full-body illusion

    Directory of Open Access Journals (Sweden)

    Laura eSchmalzl

    2011-11-01

    Full Text Available Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as telescoping. Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporarily revoke telescoping sensations in upper limb amputees. During this illusion participants view the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking, which makes them experience the mannequin’s body as their own. In Experiment 1 we used an intact mannequin, and showed that amputees can experience ownership of an intact body as well as referral of touch from both hands of the mannequin. In Experiment 2 and 3 we used an amputated mannequin, and demonstrated that depending on the spatial location of the strokes applied to the mannequin, participants experienced their phantom hand to either remain telescoped, or to actually be located below the stump. The effects were supported by subjective data from questionnaires, as well as verbal reports of the perceived location of the phantom hand in a visual judgment task. These findings are of particular interest, as they show that the temporary revoking of telescoping sensations does not necessarily have to involve the visualization of an intact hand or illusory movement of the phantom (as in the rubber hand illusion or mirror visual feedback therapy, but that it can also be obtained through mere referral of touch from the stump to the spatial location corresponding to that previously occupied by the intact hand. Moreover, our study also provides preliminary evidence for the fact that these manipulations can have an effect on phantom pain

  3. Stroke, complex regional pain syndrome and phantom limb pain: can commonalities direct future management?

    Science.gov (United States)

    Acerra, Nicole E; Souvlis, Tina; Moseley, G Lorimer

    2007-03-01

    Despite being different conditions, complex regional pain syndrome type 1, phantom limb pain and stroke share some potentially important similarities. This report examines experimental and clinical findings from each patient population. It identifies common aspects of symptomatic presentation, sensory phenomena and patterns of cortical reorganization. Based on these common findings, we argue that established principles of stroke rehabilitation are also applicable to rehabilitation of complex regional pain syndrome type 1 and phantom limb pain. In addition, we contend that promising treatment approaches for complex regional pain syndrome type 1 and phantom limb pain may be helpful in stroke rehabilitation. Examples of emerging supportive evidence for these hypotheses are provided and discussed.

  4. Bilateral restless legs affecting a phantom limb, treated with dopamine agonists.

    Science.gov (United States)

    Skidmore, F M; Drago, Valeria; Foster, P S; Heilman, K M

    2009-05-01

    Restless legs syndrome (RLS) is a common condition characterised by unpleasant sensations deep inside the legs, which usually occurs at rest and especially at night. These sensations are accompanied by an urge to move the limb, and movements result in a temporary relief of the symptoms. The pathophysiology of RLS is not completely known, especially the role of afferent feedback. An individual with a below the knee amputation who developed restless legs in his real and phantom limbs is reported. A 54-year-old man with a left leg amputation 22 years ago developed RLS, primarily at night, that met the International RLS Study Group's criteria for RLS. This RLS, however, involved both his real and phantom lower limbs. Movement and phantom movements, as well as treatment with dopamine agonists, relieved this symptom in both the real and amputated limbs. However, creating an image of the limb moving without "moving" the limb did not improve the uncomfortable sensations in either limb. That restless legs can occur simultaneously in a phantom as well as a real limb and that the perception of movement in a phantom limb as well as dopaminergic treatment improved the symptoms provides further support for the important role of central nervous system dysfunction in the development of this disorder.

  5. Functional Reorganization of the Primary Somatosensory Cortex of a Phantom Limb Pain Patient.

    Science.gov (United States)

    Zhao, Jia; Guo, Xiaoli; Xia, Xiaolei; Peng, Weiwei; Wang, Wuchao; Li, Shulin; Zhang, Ya; Hu, Li

    2016-07-01

    Functional reorganization of the somatosensory system was widely observed in phantom limb pain patients. Whereas some studies demonstrated that the primary somatosensory cortex (S1) of the amputated limb was engaged with the regions around it, others showed that phantom limb pain was associated with preserved structure and functional organization in the former brain region. However, according to the law of use and disuse, the sensitivity of S1 of the amputated limb to pain-related context should be enhanced due to the adaptation to the long-lasting phantom limb pain experience. Here, we collected neurophysiological data from a patient with 21-year phantom limb pain using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) techniques. EEG data showed that both laser-evoked potentials (LEPs) and tactile-evoked potentials (TEPs) were clearly presented only when radiant-heat laser pulses and electrical pulses were delivered to the shoulder of the healthy limb, but not of the amputated limb. This observation suggested the functional deficit of somatosensory pathways at the amputated side. FMRI data showed that significant larger brain activations by painful rather than non-painful stimuli in video clips were observed not only at visual-related brain areas and anterior/mid-cingulate cortex, but also at S1 contralateral to the amputated limb. This observation suggested the increased sensitivity of S1 of the amputated limb to the pain-related context. In addition, such increase of sensitivity was significantly larger if the context was associated with the amputated limb of the patient. In summary, our findings provided novel evidence for a possible neuroplasticity of S1 of the amputated limb: in an amputee with long-lasting phantom limb pain, the sensitivity of S1 to pain-related and amputated-limb-related context was greatly enhanced.

  6. The Effectiveness of Intravenous Morphine Infusion as Preemptive Analgesia in Preventing Phantom Limb Pain Following Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    KC Chong

    2010-11-01

    Full Text Available hantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients (Group A and intramuscular diclofenac sodium in 28 patients (Group B in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 % patients from group A and 21 patients (75 % from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p<0.05. We conclude that intravenous morphine infusion is more effective than intramuscular diclofenac sodium in preventing the occurrence of phantom limb pain following amputation.

  7. Phantom limb pain: a case of maladaptive CNS plasticity?

    DEFF Research Database (Denmark)

    Flor, Herta; Nikolajsen, Lone; Jensen, Troels Staehelin

    2006-01-01

    Phantom pain refers to pain in a body part that has been amputated or deafferented. It has often been viewed as a type of mental disorder or has been assumed to stem from pathological alterations in the region of the amputation stump. In the past decade, evidence has accumulated that phantom pain...... studies and derive suggestions for innovative interventions aimed at alleviating phantom pain....

  8. Diagnosis and Treatment of Phantom Limb Pain: Mechanisms and Option FLow Sheet.

    Science.gov (United States)

    1982-08-01

    related to causalgia like burning pain.4 u Beta blockers may be of some use to treat this portion of the problem. A recent report shows success upon...psychological aspects. Annals N.Y. Acad. Sci. 74:14, 1958. 4. Marsland, A., Weeks, J., Atkinson, R., and Leong, M.: Phantom limb pain: A case for beta ... blockers ? Pain 12, 295, 1982. 5. Meizack, R.: Phantom limb pain: Implications for treatment of pathologic pain. Anesthesiology 35(4):409, 񓟓. 6

  9. Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

    DEFF Research Database (Denmark)

    Vase, Lene; Nikolajsen, Lone; Christensen, Bente

    2011-01-01

    Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after...... amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty......-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients' level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick...

  10. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    Directory of Open Access Journals (Sweden)

    Shu eImaizumi

    2014-07-01

    Full Text Available Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation. He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic activity on deltoids at the patient’s stump. These results suggest that phantom motor sensation and electromyographic activity on the stump depend on visuomotor synchrony and top-down effects.

  11. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study.

    Science.gov (United States)

    Imaizumi, Shu; Asai, Tomohisa; Kanayama, Noriaki; Kawamura, Mitsuru; Koyama, Shinichi

    2014-01-01

    Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb) has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation). He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic (EMG) activity on deltoids at the patient's stump. These results suggest that phantom motor sensation and EMG activity on the stump depend on visuomotor synchrony and top-down effects.

  12. [Pathogenesis of phantom limb syndrome and its treatment].

    Science.gov (United States)

    Naryshkin, A G; Gurchin, F A; Samoĭlov, K A; Kirsanova, G V; Vasilevskaia, L S; Shvets, Ia M

    1989-08-01

    The spinal mechanism of the phantom pain origin is proved. The underlying factors are: segmentary spinal denervation hypersensitivity and attenuation of the descending inhibitory influence. The pathogenetic treatment of phantom pains is proposed by means of an associated treatment by GABA-ergic drug--Baclofen and alpha-2--adrenomimetic--Clofelin. Good effects of the proposed scheme of treatment confirm the correctness of the presented ideas of pathogenesis of phantom pains.

  13. From pleasure to pain: The role of the MPQ in the language of phantom limb pain.

    Science.gov (United States)

    Crawford, Cassandra S

    2009-09-01

    In opposition to the argument that pain is private, personal and unsharable, I propose that the intersubjectivity of pain is fundamental to it. Using the case of phantom limb, I show how a specific language of pain emerged and became concretized in the US circa 1975 with the advent of the McGill Pain Questionnaire (MPQ). Through widespread use of the MPQ, a language of pain materialized, one that was commonly used to describe the qualitative dimensions of phantom limb. After 1975, the terminology used within the medical literature was overwhelmingly consonant with the set of descriptors advanced by the MPQ. The utilization of a pain questionnaire to assess the qualitative dimensions of phantom limb effectively accentuated pain, and by 1980, what was once considered relatively rare became a common sequela of phantom manifestation.

  14. [Phantom limb pain syndrome: therapeutic approach using mirror therapy in a Geriatric Department].

    Science.gov (United States)

    González García, Paloma; Manzano Hernández, M Pilar; Muñoz Tomás, M Teresa; Martín Hernández, Carlos; Forcano García, Mercedes

    2013-01-01

    The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients.

  15. Motor and parietal cortex stimulation for phantom limb pain and sensations.

    Science.gov (United States)

    Bolognini, Nadia; Olgiati, Elena; Maravita, Angelo; Ferraro, Francesco; Fregni, Felipe

    2013-08-01

    Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity. The present study investigated whether transcranial direct current stimulation (tDCS), a noninvasive technique of brain stimulation that can modulate neuroplasticity, can reduce PLP. In 2 double-blind, sham-controlled experiments in subjects with unilateral lower or upper limb amputation, we measured the effects of a single session of tDCS (2 mA, 15 min) of the primary motor cortex (M1) and of the posterior parietal cortex (PPC) on PLP, stump pain, nonpainful phantom limb sensations and telescoping. Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or by motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated to a hyperexcitation of PPC that can be normalized by cathodal tDCS. This evidence highlights the relationship between the level of excitability of different cortical areas, which underpins maladaptive plasticity following limb amputation and the phenomenology of phantom limb, and it opens up new opportunities for the use of tDCS in the treatment of PLP.

  16. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    OpenAIRE

    Imaizumi, Shu; Asai, Tomohisa; Kanayama, Noriaki; Kawamura, Mitsuru; Koyama, Shinichi

    2014-01-01

    Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb) has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phanto...

  17. The effects of menthol on cold allodynia and wind-up-like pain in upper limb amputees with different levels of phantom limb pain.

    Science.gov (United States)

    Vase, Lene; Svensson, Peter; Nikolajsen, Lone; Arendt-Nielsen, Lars; Jensen, Troels Staehelin

    2013-02-08

    The mechanisms underlying phantom limb pain are not fully known, but hypersensitivity appears to be a central element. Menthol has previously been suggested as a model for hypersensitivity, but it has not yet been investigated if different levels of neuropathic pain may influence the effects of menthol or if topical application of menthol may act as a model for hypersensitivity in patients with phantom limb pain. In the present study, menthol (l-menthol 40%) was applied to the affected and non-affected sides in 24 upper-limb amputees with different levels of phantom limb pain to test if menthol could induce cold allodynia and exacerbate wind-up-like pain. The average level of phantom limb pain was significantly related to cold allodynia (P=0.044). Prior to application of menthol, the level of phantom limb pain was significantly related to the level of wind-up-like pain following both brush (P=0.040) and pinprick (P=0.033) stimulation. After application of menthol, the level of phantom limb pain was only related to wind-up-like pain following brush (P=0.011) but not pinprick stimulation (P=0.233). This study indicates that menthol does influence hypersensitivity in phantom limb pain patients, and it is the first study to show that menthol may exacerbate wind-up-like pain in this group of neuropathic pain patients. The findings suggest that menthol may act as a model for studying sensitization in phantom limb patients.

  18. Central representation of phantom limb phenomenon in amputees studied with single photon emission computerized tomography.

    Science.gov (United States)

    Liaw, M Y; You, D L; Cheng, P T; Kao, P F; Wong, A M

    1998-01-01

    To explore the possible mechanisms of phantom limb discomfort after amputation, three amputees with phantom limb pain were studied. This study examined the change of regional cerebral blood flow using technetium-99m hexamethylpropyleneamine oxime-single photon emission computerized tomography, which was arranged at the time of severe phantom limb discomfort and after the discomfort subsided or was completely relieved. Nine representative transverse slices parallel to the orbitomeatal line were selected for quantification. The cortical ribbon (2-cm thickness) was equally subdivided into 12 symmetrical pairs of sector regions of interest in each slice. The irregularly shaped regions of interest were drawn manually around the right thalamus and basal ganglion and then mirrored to the left thalamus and basal ganglion. The contralateral to ipsilateral ratio of regional cerebral blood flow for each area was calculated. The intensity of phantom limb pain was evaluated on a 0 to 10 visual analog scale. In Cases 1 and 2, the contralateral to ipsilateral regional cerebral blood flow ratios of multiple areas of the frontal, temporal, or parietal lobes were increased at the time of more severe phantom limb pain, and the ratios were normalized or even decreased when the phantom limb pain subsided. In Case 3, increased contralateral to ipsilateral regional cerebral blood flow ratios were also found over the frontal, temporal, and parietal lobe. However, most of the increased regional cerebral blood flow ratios of regions of interest in the first study persisted in the follow-up study. Also, the regional cerebral blood flow ratios of greater number of regions of interest of the same gyrus and new gyrus were increased. There was no significant right-left difference of regional cerebral blood flow over bilateral thalami and basal ganglia in all three cases. The results suggested that phantom limb pain might be associated with cortical activation involving the frontal, temporal, or

  19. 幻肢痛的研究进展%Research Progress of Phantom Limb Pain

    Institute of Scientific and Technical Information of China (English)

    王季; 甄尔传; 陈亮波

    2015-01-01

    幻肢痛是截肢后常见的并发症.随着幻肢痛病理生理机制研究的深入,幻肢痛的治疗有更多进展.幻肢痛应以综合治疗为主,应加大物理、心理治疗尤其针刺治疗的研究.%Phantom limb pain is a kind of common complication after amputation. With further researches on the pathological and physiological mechanism of phantom limb pain, whose treatment has more progress. Phantom limb pain, mainly with comprehensive treatment, should accelerate study of physical and psychological treatment, especially acupuncture treatment.

  20. Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain

    OpenAIRE

    Darnall, Beth D

    2009-01-01

    Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option t...

  1. Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain

    Science.gov (United States)

    Darnall, Beth D.

    2016-01-01

    Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care. PMID:19096290

  2. A Virtual Reality System for Treatment of Phantom Limb Pain using Game Training and Motion Tracking

    DEFF Research Database (Denmark)

    Henriksen, Bartal; Nielsen, Ronni Nedergaard; Szabo, Laszlo

    2017-01-01

    This paper describes the implementation of a phantom limb pain (PLP) home-based system using virtual reality (VR) and a motion sensor to immerse the users in a virtual environment (VE). The work is inspired by mirror therapy (MT), which has been used to relieve PLP. The target patient group focuses...... on unilateral upper-limb amputees with phantom pain. Using a motion sensor, the system tracks the movement of a user’s hand and translates it onto the virtual hand. The system consists of exercises including opening and closing the hand, rotating the hand, and finer finger movements. These exercises...

  3. 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.

  4. Plasticity in the visual system is associated with prosthesis use in phantom limb pain

    OpenAIRE

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested t...

  5. Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

    Directory of Open Access Journals (Sweden)

    C de Roos

    2010-01-01

    Full Text Available BACKGROUND: Chronic phantom limb pain (PLP is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.

  6. Treatment of chronic phantom limb pain using a trauma-focused psychological approach

    NARCIS (Netherlands)

    de Roos, C.; Veenstra, M.A.; de Jongh, A.; den Hollander-Gijsman, M.E.; van der Weer, N.J.A.; Zitman, F.G.; van Rood, Y.R.

    2010-01-01

    BACkgRound: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.

  7. A systematic review on the treatment of phantom limb pain with spinal cord stimulation.

    Science.gov (United States)

    Aiyer, Rohit; Barkin, Robert L; Bhatia, Anurag; Gungor, Semih

    2017-01-01

    Phantom limb pain (PLP) is a challenging chronic pain syndrome to treat with pharmacologic agents being first line of management. However, when these agents fail to provide pain relief, other interventions must be considered in a clinical setting. Spinal cord stimulation (SCS) has been shown to provide analgesia in PLP, and should be considered by clinicians.

  8. Phantom Pain

    Science.gov (United States)

    ... is still there. This painless phenomenon, known as phantom limb sensation, may rarely occur in people who were born without limbs. Phantom limb sensations may include feelings of coldness, warmth, or ...

  9. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    Directory of Open Access Journals (Sweden)

    Li S

    2015-04-01

    Full Text Available Shengai Li,1,2 Danielle H Melton,1,2 Sheng Li1,2 1Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA; 2Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA Purpose: To examine whether there is central sensitization in patients with phantom limb pain (PLP after traumatic limb amputation. Methods: Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST, and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups. Results: The novel findings included: 1 electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2 EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups. Conclusion: Our results demonstrate central sensitization in the patients with PLP after traumatic limb amputation. Keywords: central sensitization, pain threshold, human

  10. Phantoms in artists: the lost limbs of Blaise Cendrars,Arthur Rimbaud, and Paul Wittgenstein.

    Science.gov (United States)

    Tatu, Laurent; Bogousslavsky, Julien; Boller, François

    2014-01-01

    There have been an increasing number of reports of postamputation pain and problems linked to phantom limbs over recent years, particularly in relation to war-related amputations. These problems, which are often poorly understood and considered rather mysterious, are still relevant because they are difficult to treat medically. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Phantom limbs have often been a source of inspiration to writers, particularly in the period following the First World War, which was responsible for thousands of amputees. Some artists have suffered from postamputation complications themselves and have expressed them through their artistic works. Blaise Cendrars (1887-1961), one of the greatest authors of the twentieth century, suffered from stump pain and phantom limb phenomena for almost half a century following the amputation of his right arm during the First World War. He suffered from these phenomena until the end of his life and his literary work and personal correspondence are peppered with references to them. Arthur Rimbaud (1854-1891), one of the most famous poets in world literature, developed severe stump pain after his right leg was amputated due to a tumor. He survived for only six months after the procedure but left behind an account of the pain he experienced in correspondence to his family. The famous pianist Paul Wittgenstein (1887-1961), whose right arm was amputated during the First World War, became a famous left-handed concert pianist. The phantom movements of his right hand helped him to develop the dexterity of his left hand. The impact on the artistic life of these three men provides an original illustration of the various postamputation complications, specifically phantom limbs, stump pain, and moving phantom.

  11. Prevalence of phantom limb pain, stump pain, and phantom limb sensation among the amputated cancer patients in India: A prospective, observational study

    Directory of Open Access Journals (Sweden)

    Arif Ahmed

    2017-01-01

    Full Text Available Introduction: The phantom limb pain (PLP and phantom limb sensation (PLS are very common among amputated cancer patients, and they lead to considerable morbidity. In spite of this, there is a lack of epidemiological data of this phenomenon among the Asian population. This study was done to provide the data from Indian population. Methods: The prevalence of PLP, stump pain (SP, and PLS was prospectively analyzed from the amputated cancer patients over a period of 2 years in Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. The risk factors and the impact of phantom phenomenon on patients were also noted. Results: The prevalence of PLP was 41% at 3 and 12 months and 45.3% at 6 months, whereas that of SP and PLS was 14.4% and 71.2% at 3 months, 18.75% and 37.1% at 6 months, 15.8% and 32.4% at 12 months, respectively. There was higher prevalence of PLP and PLS among the patients with history of preamputation pain, smoking with proximal level of amputation, receiving general anesthesia, receiving intravenous (IV opioid postoperative analgesia, and developing neuroma or infection. Conclusion: The prevalence of PLP and PLS was higher among the cancer amputees as compared to SP, and a few risk factors responsible for their higher prevalence were found in our study. The PLP and PLS lead to considerable morbidity in terms of sleep disturbance and depression.

  12. Long-term motor cortex stimulation for phantom limb pain.

    Science.gov (United States)

    Pereira, Erlick A C; Moore, Tom; Moir, Liz; Aziz, Tipu Z

    2015-04-01

    We present the long-term course of motor cortex stimulation to relieve a case of severe burning phantom arm pain after brachial plexus injury and amputation. During 16-year follow-up the device continued to provide efficacious analgesia. However, several adjustments of stimulation parameters were required, as were multiple pulse generator changes, antibiotics for infection and one electrode revision due to lead migration. Steady increases in stimulation parameters over time were required. One of the longest follow-ups of motor cortex stimulation is described; the case illustrates challenges and pitfalls in neuromodulation for chronic pain, demonstrating strategies for maintaining analgesia and overcoming tolerance.

  13. Radicular pain from lumbar canal stenosis in addition to pre-existing phantom limb pain.

    Science.gov (United States)

    Tomasi, S O; Ghani, I; Waldvogel, D; Hausmann, O

    2013-12-01

    Phantom limb (PL) is a term used to designate the sensation of the presence of an extremity following amputation, and it may be seen immediately after injury or years later in the part of the body that is deafferented or amputated. Phantom limb pain (PLP) is the term used to describe painful sensations referred to the absent limb. We present a case of a 71-year-old male with spinal claudication from discoligamentous lumbar canal stenosis L3-L4 and L4-L5 with L5 radicular pain in the left PL 13 years after the amputation. The patient had a disappearance of his radicular pain in the left PL following microsurgical lumbar decompression of L3-L4 and L4-L5. This is one of the rare cases reported in the literature in which a radicular pain in the PL disappeared following surgical decompression of the spinal canal.

  14. Phantom phenomena and body scheme after limb amputation: a literature review.

    Science.gov (United States)

    Pirowska, Aneta; Wloch, Tomasz; Nowobilski, Roman; Plaszewski, Maciej; Hocini, Abdellah; Ménager, Doménico

    2014-01-01

    Phantom phenomena are subject of various, often inconsistent, descriptions, and new concepts and treatment approaches emerge. The aim of the study is to describe contemporary terminology and developments in the field, and to share personal experience. A review of English and French language literature, published prior to 27th February, 2012, extracted from PubMed/MEDLINE, Google.fr, GoogleScholar databases, and by hand searching of selected full text papers and textbooks with correspondence to personal clinical experience was performed. The terminology and classification of phantom phenomena sensations, relations between intensity and character of phantom pain to the etiology and level of amputations, as well as the influence of presence and intensity of pre-operative limb pain and post-operative stump pain on phantom phenomena are described. The benefits of mirror therapy and early introduction of prosthesis and applying functional prosthesis are also presented, with a glance at other conservative and surgical treatment approaches.

  15. Cross-sectional study of alteration of phantom limb pain with visceral stimulation in military personnel with amputation.

    Science.gov (United States)

    Rafferty, Michael; Bennett Britton, Thomas M; Drew, Benjamin T; Phillip, Rhodri D

    2015-01-01

    While phantom limb pain is a well-recognized phenomenon, clinical experience has suggested that the augmentation of phantom limb pain with visceral stimulation is an issue for many military personnel with amputation (visceral stimulation being the sensation of the bowel or bladder either filling or evacuating). However, the prevalence of this phenomenon is not known. The aim of this study was to investigate the prevalence of the alteration in phantom limb pain and the effect that visceral stimulation has on phantom limb pain intensity. A cross-sectional study of 75 military personnel who have lost one or both lower limbs completed a questionnaire to assess the prevalence of the alteration of phantom limb pain with visceral stimulation. Included in the questionnaire was a pain visual analog scale (VAS) graded from 0 to 10. Patients recorded the presence and intensity of phantom limb pain. They also recorded whether and how this pain altered with a need to micturate or micturition, and/or a need to defecate or defecation, again using a pain VAS. Time since amputation, level of amputation, and medications were also recorded. Patients reported a phantom limb pain prevalence of 85% with a mean VAS of 3.6. In all, 56% of patients reported a change in the severity of phantom limb pain with visceral stimuli. The mean increase in VAS for visceral stimulation was 2.5 +/- 1.6 for bladder stimulation and 2.9 +/- 2.0 for bowel stimulation. Of the patients questioned, 65% reported an improvement in symptoms over time. VAS scores were highest in the subgroup less than 6 mo postamputation. An increase in phantom limb pain with visceral stimulation is a common problem for military personnel with amputation.

  16. Persistence of secondary restless legs syndrome in a phantom limb caused by end-stage renal disease.

    Science.gov (United States)

    Nishida, Shingo; Hitsumoto, Akiko; Namba, Kazuyoshi; Usui, Akira; Inoue, Yuichi

    2013-01-01

    Our patient had secondary restless legs syndrome (RLS) in the left lower limb caused by end-stage renal disease (ESRD). Severe RLS symptoms persisted even after amputation of the affected limb. Considering that oral administration of a dopamine receptor agonist was effective in treating the RLS in the phantom limb in this case, dysfunction of the central dopaminergic system was thought to be involved in the phantom limb-RLS mechanism. The persistence of RLS symptoms even after amputation of the affected limb suggests that the area responsible for ESRD-related RLS symptoms exists at the spinal level or in the higher central nervous system.

  17. Mirror therapy for phantom limb pain in an adolescent cancer survivor.

    Science.gov (United States)

    Clerici, Carlo Alfredo; Spreafico, Filippo; Cavallotti, Gaia; Consoli, Annalisa; Veneroni, Laura; Sala, Alessio; Massimino, Maura

    2012-01-01

    Several pediatric tumors require mutilating procedures in order to be treated effectively. Although the pain caused by the surgery is usually of a transient nature, the perception of pain in the amputated limb may persist. This prolonged pain, which is often refractory to pain-killing medication, may severely affect the patient's quality of life. The phenomenon of phantom limb pain (or phantom limb syndrome) has been investigated using neurological, neurophysiological and psychopathological approaches. Here we discuss the advantages of an unconventional rehabilitation technique, the recently reported mirror therapy, whose positive effects might be due, according to some researchers, to neuronal plasticity mechanisms. We describe the use of mirror therapy to treat phantom limb syndrome in a 39-year-old patient whose right leg had been amputated at the age of 17 because of an osteosarcoma. The patient suffered from frequent episodes of pain, with severely negative effects on his quality of life. We obtained positive subjective feedback from the patient, who reported having benefited significantly from using the mirror. The beneficial effect was still present six months after the start of mirror therapy. The reported case highlights the value of an integrated multidisciplinary approach including neurological/physiatric assessment, clinical psychological support, physiotherapy and other, unconventional treatment modalities. This report should guide future studies towards the application of mirror therapy in order to elucidate its effects and efficacy.

  18. An Affordable Virtual Reality System for Treatment of Phantom Limb Pain

    DEFF Research Database (Denmark)

    Henriksen, Bartal; Nielsen, Ronni Nedergaard; Szabo, Laszlo

    2016-01-01

    This paper describes the implementation of an affordable phantom limb pain (PLP) home treatment system using virtual reality (VR) and a motion sensor to immerse the users in a virtual environment (VE). The work is inspired by mirror therapy (MT) which is used to treat patients with PLP....... This project focuses on phantom pain in amputees. Using a motion sensor, the system tracks the movement of a user’s hand and translates it onto the virtual hand. The system consists of exercises focusing on opening and closing the hand, rotating the hand, and finer finger movements. These exercises...

  19. [The Research Advances of the Pathomechanism of Phantom Limb Pain (PLP)].

    Science.gov (United States)

    Jin, Qing-Qing; Tang, Dan-Dan; Peng, Wei-Wei; Hu, Li

    2015-10-01

    Phantom limb pain (PLP) is a hallucination that the patient feels the existence off the limb after its loss and experiences somewhat pain of the missing limb. Such a pain normally appears in the distal end of the missing limb. Currently, the pathomechanism of PLP is still unclear, and the clinical research of PLP mainly relies on the subjective report of the patients and the psychophysical measurements. In this paper, we discuss extensively the pathomechanism of PLP, and summarize comprehensively the advanced methods for studying the pathomechanism of PLP. In short, the paper could deepen our understanding of the pathomechanism of PLP, and could serve as an effective instruction basis for researchers and doctors to diagnose and treat the PLP.

  20. Long-term high-dose oral morphine in phantom limb pain with no addiction risk

    Directory of Open Access Journals (Sweden)

    Vinod Kumar

    2015-01-01

    Full Text Available Chronic phantom limb pain (PLP is a type of neuropathic pain, which is located in the missing/amputated limb. Phantom pain is difficult to treat as the exact basis of pain mechanism is still unknown. Various methods of treatment for PLP have been described, including pharmacological (NSAIDs, opioids, antiepileptic, antidepressants and non-pharmacological (TENS, sympathectomy, deep brain stimulation and motor cortex stimulation. Opioids are used for the treatment of neuropathic pain and dose of opioid is determined based on its effect and thus there is no defined ceiling dose for opioids. We report a case where a patient receiving high-dose oral morphine for chronic cancer pain did not demonstrate signs of addiction.

  1. Know pain know gain: proposing a treatment approach for phantom limb pain.

    Science.gov (United States)

    Le Feuvre, Peter; Aldington, D

    2014-03-01

    Phantom limb pain affects between 50 and 80% of amputees. With an increasing number of battle casualties having had an amputation after combat trauma, it is inevitable that both primary and secondary care clinicians will come into contact with a patient with phantom limb pain (PLP). It is widely acknowledged that its complex aetiology means that this condition is often poorly understood and difficult to manage. A growing pathophysiological understanding is shedding new light on the mechanisms which underlie PLP. Knowledge of these mechanisms will inform treatment and enable clinicians to plan and implement solutions which make a difference to those individuals with this condition. This paper seeks to outline current research into this condition and proposes an approach to treatment. This approach has been formulated from an amalgamation of clinical experience working with battle casualties at the Defence Medical Rehabilitation Centre, Headley Court.

  2. Update of phantom limb pain%幻肢痛的研究进展

    Institute of Scientific and Technical Information of China (English)

    朱天琦; 蒋宗滨; 赵劲民; 彭宇

    2010-01-01

    With growing incidence of traffic accidents, malignant diseases and natural disasters, patients to be amputated are getting more and more. Consequently, the incidence of phantom limb pain increases, with unaware mechanisms, and with no effective therapy. This reviewer reports the update of phantom limb pain.%随着交通事故、恶性疾病、自然灾害的不断增多,行截肢术的患者也越来越多.有资料显示,目前幻肢痛患者人数在不断增加,但发生机制还未完全阐明,治疗方法虽然不断更新但仍无重大突破.现就幻肢痛的研究进展作一综述.

  3. Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

    OpenAIRE

    Roos, C.; AC Veenstra; de Jongh, A.; ME den Hollander-Gijsman; NJA van der Wee; Zitman FG; YR van Rood

    2010-01-01

    BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP.METHODS: Ten consecutive participan...

  4. Ultrasound-guided posterior approach to brachial plexus for the treatment of upper phantom limb syndrome.

    Science.gov (United States)

    Tognù, A; Borghi, B; Gullotta, S; White, P F

    2012-01-01

    The purpose of the case is to report the clinical value of the ultrasound-guided posterior approach to the brachial plexus in the treatment of phantom limb syndrome after an upper extremity amputation. The author experienced ultrasound guidance as sole technique to localize the brachial plexus for the purpose of placing a catheter for continuous infusion of a local anesthetic in a patient where standard landmark-based nerve stimulation for placement of a continuous perineural block was not possible.

  5. Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks

    Science.gov (United States)

    2016-01-01

    appetite is much greater than usual. 3a You have no appetite at all. 3b You crave food all the time. ! 19) Concentration Difficulty: 0 You can...advertisement, enrollment table by institution, and study questionnaires are included on the following pages. Do you have phantom limb pain...Administered by (initials): ___ ___ Questionnaire Date: ____ / ____ / 201 ____ If form not completed: ! Subject could not be contacted ! Subject

  6. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    Directory of Open Access Journals (Sweden)

    Alireza eGharabaghi

    2014-05-01

    Full Text Available Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. This bi-directional interface enabled us to explore the cortical physiology following long-term transhumeral amputation. In addition, we investigated neurofeedback of electrocorticographic brain activity related to the patient’s motor imagery to open his missing hand, i.e. phantom hand movement, for real-time control of a virtual hand prosthesis.Results: Both event-related brain potentials and cortical stimulation revealed mutually overlapping cortical representations of the phantom hand. Phantom hand movements could be robustly classified and the patient required only three training sessions to gain reliable control of the virtual hand prosthesis in an online closed-loop paradigm that discriminated between hand opening and rest. Conclusion: Epidural implants may constitute a powerful and safe alternative communication pathway between the brain and external devices for upper-limb amputees, thereby facilitating the integrated use of different signal sources for more intuitive and specific control of multi-functional devices in clinical use.

  7. Follow-up 26 years after dorsal root entry zone thermocoagulation for brachial plexus avulsion and phantom limb pain.

    Science.gov (United States)

    Tomycz, Nestor D; Moossy, John J

    2011-01-01

    Brachial plexus avulsion and limb amputation are often associated with intractable chronic pain. Dorsal root entry zone (DREZ) thermocoagulation is an effective surgical treatment for upper-extremity deafferentation pain. The authors describe the clinical follow-up and imaging in a patient who underwent DREZ thermocoagulation 26 years ago for postamputation phantom limb syndrome with associated brachial plexus avulsion. This patient continues to have successful pain control without phantom limb sensation and has never experienced a recurrence of his left upper-extremity pain syndrome. This report lends credibility to the notion that, among ablative neurosurgical pain operations, DREZ thermocoagulation may provide the greatest durability of pain control.

  8. Consciousness and body image: lessons from phantom limbs, Capgras syndrome and pain asymbolia.

    Science.gov (United States)

    Ramachandran, V S

    1998-11-29

    Words such as 'consciousness' and 'self' actually encompass a number of distinct phenomena that are loosely lumped together. The study of neurological syndromes allows us to explore the neural mechanisms that might underlie different aspects of self, such as body image and emotional responses to sensory stimuli, and perhaps even laughter and humour. Mapping the 'functional logic' of the many different attributes of human nature on to specific neural circuits in the brain offers the best hope of understanding how the activity of neurons gives rise to conscious experience. We consider three neurological syndromes (phantom limbs, Capgras delusion and pain asymbolia) to illustrate this idea.

  9. Beyond body experiences: phantom limbs, pain and the locus of sensation.

    Science.gov (United States)

    Wade, Nicholas J

    2009-02-01

    Reports of perceptual experiences are found throughout history. However, the phenomena considered worthy of note have not been those that nurture our survival (the veridical features of perception) but the oddities or departures from the common and commonplace accuracies of perception. Some oddities (like afterimages) could be experienced by everyone, whereas others were idiosyncratic. Such phenomena were often given a paranormal interpretation before they were absorbed into the normal science of the day. This sequence is examined historically in the context of beyond body experiences or phantom limbs. The experience of sensations in lost body parts provides an example of the ways in which novel phenomena can be interpreted. The first phase of description probably occurred in medieval texts and was often associated with accounts of miraculous reconnection. Ambroise Paré (1510-1590) initiated medical interest in this intriguing aspect of perception, partly because more of his patients survived the trauma of surgery. Description is followed by attempts to incorporate the phenomenon into the body of extant theory. René Descartes (1596-1650) integrated sensations in amputated limbs into his dualist theory of mind, and used the phenomenon to support the unity of the mind in comparison to the fragmented nature of bodily sensations. Others, like William Porterfield (ca. 1696-1771), did not consider the phenomenon as illusory and interpreted it in terms of other projective features of perception. Finally, the phenomenon is accepted and utilized to gain more insights into the functioning of the senses and the brain. The principal features of phantom limbs were well known before they were given that name in the 19th century. Despite the puzzles they still pose, these phantoms continue to provide perception with some potent concepts: the association with theories of pain has loosened the link with peripheral stimulation and emphasis on the phenomenal dimension has slackened

  10. [Mirror therapy for the treatment of phantom limb pain after bilateral thigh amputation. A case report].

    Science.gov (United States)

    Wosnitzka, M; Papenhoff, M; Reinersmann, A; Maier, C

    2014-12-01

    This case study is the first to report successful treatment of bilateral phantom limb pain (PLP) in a patient with bilateral thigh amputation and inefficacious medical treatment using a protocol of graded interventions including mirror therapy (MT). MT is a common treatment for PLP but requires the induction of a visual illusion of an intact limb in the mirror, usually achieved by mirroring the healthy extremity. Here, we illustrate how application of a unilateral prosthesis sufficed to induce the necessary illusion. After sequential imagery, then lateralization training, which alleviated pain attacks, the patient received a further 3-week treatment of mirror treatment. Pain intensity was reduced by more than 85 %; the number of attacks were decreased by more than 90% per day. The analgesic efficacy lasted until the unexpected death of the patient several months later. This case illustrates the mechanisms of MT through overcoming the sensory incongruences underlying the distorted body schema and its efficacy in patients with bilateral amputation.

  11. Mirror therapy for phantom limb pain: brain changes and the role of body representation.

    Science.gov (United States)

    Foell, J; Bekrater-Bodmann, R; Diers, M; Flor, H

    2014-05-01

    Phantom limb pain (PLP) is a common consequence of amputation and is difficult to treat. Mirror therapy (MT), a procedure utilizing the visual recreation of movement of a lost limb by moving the intact limb in front of a mirror, has been shown to be effective in reducing PLP. However, the neural correlates of this effect are not known. We investigated the effects of daily mirror training over 4 weeks in 13 chronic PLP patients after unilateral arm amputation. Eleven participants performed hand and lip movements during a functional magnetic resonance imaging (fMRI) measurement before and after MT. The location of neural activity in primary somatosensory cortex during these tasks was used to assess brain changes related to treatment. The treatment caused a significant reduction of PLP (average decrease of 27%). Treatment effects were predicted by a telescopic distortion of the phantom, with those patients who experienced a telescope profiting less from treatment. fMRI data analyses revealed a relationship between change in pain after MT and a reversal of dysfunctional cortical reorganization in primary somatosensory cortex. Pain reduction after mirror training was also related to a decrease of activity in the inferior parietal cortex (IPC). Experienced body appearance seems to be an important predictor of mirror treatment effectiveness. Maladaptive changes in cortical organization are reversed during mirror treatment, which also alters activity in the IPC, a region involved in painful perceptions and in the perceived relatedness to an observed limb. © 2013 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.

  12. Trajectory of phantom limb pain relief using mirror therapy: Retrospective analysis of two studies.

    Science.gov (United States)

    Griffin, Sarah C; Curran, Sean; Chan, Annie W Y; Finn, Sacha B; Baker, Chris I; Pasquina, Paul F; Tsao, Jack W

    2017-04-01

    Research indicates that mirror therapy reduces phantom limb pain (PLP). Objectives were to determine when mirror therapy works in those who respond to treatment, the relevance of baseline PLP to when pain relief occurs, and what pain symptoms respond to mirror therapy. Data from two independent cohorts with unilateral lower limb amputation were analyzed for this study (n=33). Mirror therapy consisted of 15-min sessions in which amputees performed synchronous movements of the phantom and intact legs/feet. PLP was measured using a visual analogue scale and the Short-Form McGill Pain Questionnaire. The severity of PLP at the beginning of treatment predicted when pain relief occurred. Those with low baseline PLP experienced a reduction (pMirror therapy reduced throbbing, shooting, stabbing, sharp, cramping, aching, tender, splitting, tiring/exhausting, and punishing-cruel pain symptoms. The degree of PLP at baseline predicts when mirror therapy relieves pain. This article indicates that the degree of baseline PLP affects when mirror therapy relieves pain: relief occurs by session 7 in patients with low PLP but by session 21 in patients with high PLP. Clinicians should anticipate slower pain relief in patients who begin treatment with high levels of pain. ClinicalTrials.gov numbers:NCT00623818 and NCT00662415. Copyright © 2017 Scandinavian Association for the Study of Pain. All rights reserved.

  13. Treatment of phantom limb pain by cryoneurolysis of the amputated nerve.

    Science.gov (United States)

    Moesker, Albert A; Karl, Helen W; Trescot, Andrea M

    2014-01-01

    The pathophysiology of phantom limb pain (PLP) is multifactorial. It probably starts in the periphery and is amplified and modified in the central nervous system. A small group of patients with PLP were questioned as to the portion of the phantom limb affected by pain (e.g., "great toe," "thumb"). In the stump, the corresponding amputated nerve was located with a nerve stimulator. With correct placement and stimulation, the PLP could then be reproduced or exacerbated. A small dose of local anesthesia was then injected, resulting in the disappearance of the PLP. If a peripheral nerve injection gave temporary relief, our final treatment was cryoanalgesia at this location. Evaluation of 5 patients, followed for at least 2.5 years, yielded the following results: 3 patients had excellent results (100%, 95%, and 90% decrease in complaints, respectively), 1 patient had an acceptable result (40% decrease), and 1 patient had only a 20% decrease in pain. Although both central and peripheral components are likely involved in PLP, treatment of a peripheral pain locus with cryoanalgesia should be considered. We propose the identification of a peripheral etiology may help match patients to an appropriate therapy, and cryoanalgesia may result in long-term relief of PLP.

  14. A review of the management of phantom limb pain: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Richardson C

    2017-08-01

    Full Text Available Cliff Richardson,1 Jai Kulkarni2 1University of Manchester, Division of Nursing Midwifery and Social Work, Manchester, UK, 2Specialized Ability Centre (Manchester, University Hospitals of South Manchester NHS Foundation Trust, Manchester, UK Background: Phantom limb pain (PLP occurs in 50% and 80% of amputees. Although it is often classified as a neuropathic pain, few of the large-scale trials of treatments for neuropathic pain included sufficient numbers of PLP sufferers to have confidence that they are effective in this condition. Many therapies have been administered to amputees with PLP over the years; however, as of yet, there appears to be no first-line treatment. Objectives: To comprehensively review the literature on treatment modalities for PLP and to identify the challenges currently faced by clinicians dealing with this pain. Method: MEDLINE, EMBASE, CINAHL, British Nursing Index, Cochrane and psycINFO databases were searched using “Phantom limb” initially as a MeSH term to identify treatments that had been tried. Then, a secondary search combining phantom limb with each treatment was performed to find papers specific to each therapy. Each paper was assessed for its research strength using the GRADE system. Results: Thirty-eight therapies were identified. Overall, the quality of evidence was low. There was one high-quality study which used repetitive transcutaneous magnetic stimulation and found a statistical reduction in pain at day 15 but no difference at day 30. Significant results from single studies of moderate level quality were available for gabapentin, ketamine and morphine; however, there was a risk of bias in these papers. Mirror therapy and associated techniques were assessed through two systematic reviews, which conclude that there is insufficient evidence to support their use. Conclusion: No decisions can be made for the first-line management of PLP, as the level of evidence is too low. Robust studies on homogeneous

  15. The deafferentation syndrome in genetically blind rats: a model of the painful phantom limb.

    Science.gov (United States)

    Levitt, M; Heybach, J P

    1981-02-01

    The hypothesis was tested which states that the somatic deafferentation syndrome is a visually prompted response to sensorimotor loss. The dorsal roots, C5-T2, were bilaterally cut in a strain of rats known to be genetically blind. These complete dorsal rhizotomies left the forelimbs totally anesthetic, analgesic and paretic. Contact and visual placing reactions were absent, and responses to pinprick or pinch were absent. Self-mutilation limited to the distal digits appeared on the first or second postoperative days and then progressed proximally. The forelimbs were symmetrically affected, and no other body parts were mutilated. The spatial precision of this syndrome, in the absence of visual as well as peripheral somatosensory information from the affected limb, indicates that controlled guidance of the behavior arises from an existing central representation of the limb and its relationship with the total body; a phantom limb. Consideration of other reports regarding the deafferentation syndrome leads to the view that it is motivated by disturbing abnormal sensations (pain) of central neural origin.

  16. P300-amplitudes in upper limb amputees with and without phantom limb pain in a visual oddball paradigm.

    Science.gov (United States)

    Karl, Anke; Diers, Martin; Flor, Herta

    2004-07-01

    The aim of the study was to investigate to what extent cortical hyper-reactivity to visual stimuli is present in upper limb amputees. Five amputees with phantom limb pain (PLP), five amputees without PLP (Non-PLP) and 10 healthy controls (HC) were investigated using a visual oddball paradigm. Two hundred visual stimuli were presented with target stimuli occurring at a probability of 25% and standard stimuli at a probability of 75%. Event-related potentials were recorded from nine scalp positions (F3, F4, Fz, C3, C4, Cz, P3, P4, Pz). The PLP-patients had significantly higher P300-amplitudes to both types of stimuli compared to the non-PLP-patients. The HC were not significantly different from both amputee groups. P300-amplitude to targets at frontal sites in the hemisphere contralateral to the amputation was higher in the PLP patients. P300-latencies to target stimuli differed only at frontal sites with PLP-patients showing significantly longer latencies than non-PLP-patients. To standard stimuli, however, they showed significantly shorter latencies at central and parietal scalp positions. The HC had significantly shorter latencies than both amputee groups. The size of the P300-amplitude was positively correlated with the intensity of PLP. These findings suggest a higher magnitude of non-specific cortical excitability in amputees with PLP and a reduced excitability in amputees without PLP. This extends previous findings of differences in cortical excitability in PLP and non-PLP patients in the sensorimotor domain.

  17. Real-time Classification of Non-Weight Bearing Lower-Limb Movements Using EMG to Facilitate Phantom Motor Execution: Engineering and Case Study Application on Phantom Limb Pain

    Directory of Open Access Journals (Sweden)

    Eva Lendaro

    2017-09-01

    Full Text Available Phantom motor execution (PME, facilitated by myoelectric pattern recognition (MPR and virtual reality (VR, is positioned to be a viable option to treat phantom limb pain (PLP. A recent clinical trial using PME on upper-limb amputees with chronic intractable PLP yielded promising results. However, further work in the area of signal acquisition is needed if such technology is to be used on subjects with lower-limb amputation. We propose two alternative electrode configurations to conventional, bipolar, targeted recordings for acquiring surface electromyography. We evaluated their performance in a real-time MPR task for non-weight-bearing, lower-limb movements. We found that monopolar recordings using a circumferential electrode of conductive fabric, performed similarly to classical bipolar recordings, but were easier to use in a clinical setting. In addition, we present the first case study of a lower-limb amputee with chronic, intractable PLP treated with PME. The patient’s Pain Rating Index dropped by 22 points (from 32 to 10, 68% after 23 PME sessions. These results represent a methodological advancement and a positive proof-of-concept of PME in lower limbs. Further work remains to be conducted for a high-evidence level clinical validation of PME as a treatment of PLP in lower-limb amputees.

  18. Ketamina en el dolor del miembro fantasma Ketamine and phantom limb pain

    Directory of Open Access Journals (Sweden)

    M. Mayo Moldes

    2009-12-01

    Full Text Available El dolor en miembro fantasma es una de las principales complicaciones a largo plazo tras la amputación de un miembro. Entre las opciones disponibles y que cuentan con respaldo bibliográfico de casos puntuales, se encuentra el uso de la ketamina. Se presenta el caso de un varón de 65 años, con dolor en miembro fantasma desde hacia 10 años, con respuesta parcial a los anticonvulsionantes y antidepresivos. El paciente refería un dolor basal de 4, medido con la escala visual analógica, y episodios frecuentes de dolor lancinante de 10. El índice de Lattinen tenía un valor de 12 y, además, el paciente estaba deprimido y con afectación de su vida familiar. Ante esta situación decidimos, tras revisar la bibliografía, citarlo para perfusión continua intravenosa de ketamina. Evaluamos al paciente a la semana, a los 3 y a los 6 meses con un EVA a los 6 meses de 0 en reposo y con disminución de los episodios de dolor lancinante menos de 2 a la semana, con un EVA en estos episodios de 6, Lattinen de 5 y mejoría del estado de ánimo.Phantom limb pain is one of the main long-term complications of amputation. Among the available options that have been reported in sporadic cases in the literature is the use of ketamine. We present the case of a 65-year-old man with phantom limb pain for 10 years and partial response to anticonvulsants and antidepressants. The patient reported a baseline visual analog scale (VAS pain score of 4 and frequent episodes of lancinating pain with a score of 10. The Lattinen index was 12. The patient was depressed with repercussions on his family life.

  19. Current and future options for the management of phantom-limb pain

    Directory of Open Access Journals (Sweden)

    Knotkova H

    2012-03-01

    Full Text Available Helena Knotkova1,2, Ricardo Cruciani1–3, Volker M Tronnier4, Dirk Rasche41Department of Pain Medicine and Palliative Care, Research Division, Institute for Non-invasive Brain Stimulation, Beth Israel Medical Center, New York, NY, USA; 2Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA; 4Department of Neurosurgery, University of Lübeck, GermanyAbstract: Phantom-limb pain (PLP belongs among difficult-to-treat chronic pain syndromes. Treatment options for PLP are to a large degree implicated by the level of understanding the mechanisms and nature of PLP. Research and clinical findings acknowledge the neuropathic nature of PLP and also suggest that both peripheral as well as central mechanisms, including neuroplastic changes in central nervous system, can contribute to PLP. Neuroimaging studies in PLP have indicated a relation between PLP and the neuroplastic changes. Further, it has been shown that the pathological neuroplastic changes could be reverted, and there is a parallel between an improvement (reversal of the neuroplastic changes in PLP and pain relief. These findings facilitated explorations of novel neuromodulatory treatment strategies, adding to the variety of treatment approaches in PLP. Overall, available treatment options in PLP include pharmacological treatment, supportive non-pharmacological non-invasive strategies (eg, neuromodulation using transcranial magnetic stimulation, visual feedback therapy, or motor imagery; peripheral transcutaneous electrical nerve stimulation, physical therapy, reflexology, or various psychotherapeutic approaches, and invasive treatment strategies (eg, surgical destructive procedures, nerve blocks, or invasive neuromodulation using deep brain stimulation, motor cortex stimulation, or spinal cord stimulation. Venues of further development in PLP management include a technological and

  20. The effect of mirror therapy on the management of phantom limb pain.

    Science.gov (United States)

    Yıldırım, Meltem; Kanan, Nevin

    2016-07-01

    In the last two decades, mirror therapy has become a frequently used method of managing phantom limb pain (PLP). However, the role of nurses in mirror therapy has not yet been well defined. This study examined the effect of mirror therapy on the management of PLP, and discusses the importance of mirror therapy in the nursing care of amputee patients. This quasi-experimental study was conducted in the pain management department of a university hospital and a prosthesis clinic in İstanbul, Turkey, with 15 amputee patients who had PLP. Forty minutes of practical mirror therapy training was given to the patients and they were asked to practice at home for 4 weeks. Patients were asked to record the severity of their PLP before and after the therapy each day using 0-10 Numeric Pain Intensity Scale. Mirror therapy practiced for 4 weeks provided a significant decrease in severity of PLP. There was no significant relationship between the effect of mirror therapy and demographic, amputation or PLP-related characteristics. Patients who were not using prosthesis had greater benefit from mirror therapy. Mirror therapy can be used as an adjunct to medical and surgical treatment of PLP. It is a method that patients can practice independently, enhancing self-control over phantom pain. As mirror therapy is a safe, economical, and easy-to-use treatment method, it should be considered in the nursing care plan for patients with PLP.

  1. The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review.

    Science.gov (United States)

    Barbin, J; Seetha, V; Casillas, J M; Paysant, J; Pérennou, D

    2016-09-01

    Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in PLP and phantom limb movement (PLM) in amputees (lower or upper limb). A search on Medline, Cochrane Database and Embase, crossing the keywords "Phantom Limb" and "Mirror Therapy" found studies which were read and analyzed according the PRISMA statement. Twenty studies were selected, 12 on the subject of MT and PLP, 3 on MT and PLM, 5 on MT and both (PLP and PLM). Among these 20 studies, 5 were randomized controlled trials (163 patients), 6 prospective studies (55 patients), 9 case studies (40 patients) and methodologies were heterogeneous. Seventeen of the 18 studies reported the efficacy of MT on PLP, but with low levels of evidence. One randomized controlled trial did not show any significant effect of MT. As to the effect of MT on PLM, the 8 studies concerned reported effectiveness of MT: 4 with a low level of evidence and 4 with a high level of evidence. An alternative to visual illusion seems to be tactile or auditory stimulation. We cannot recommend MT as a first intention treatment in PLP. The level of evidence is insufficient. Further research is needed to assess the effect of MT on pain, prosthesis use, and body representation, and to standardize protocols. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Plasticity in the visual system is associated with prosthesis use in phantom limb pain

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    Sandra ePreißler

    2013-06-01

    Full Text Available The experience of strong phantom limb pain (PLP in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand.To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested the association between the amount of use of the hand prosthesis and cortical volume plasticity.On the behavioral level, we found no relation between PLP and the amount of prosthesis use for the whole patient group. However, by subdividing the patient group into patients with strong PLP and those with low to medium PLP, stronger pain was significantly associated with less prosthesis use whereas the group with low PLP did not show such an association.Most plasticity of cortical volume was identified within the dorsal stream. The more the patients that suffered from strong PLP used their prosthesis, the smaller was the volume of their posterior parietal cortex.Our data indicate a relationship between prosthesis use and cortical plasticity of the visual stream. This plasticity might present a brain adaption process to new movement and coordination patterns needed to guide an artificial hand.

  3. Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain.

    Science.gov (United States)

    Diers, Martin; Christmann, Christoph; Koeppe, Caroline; Ruf, Matthias; Flor, Herta

    2010-05-01

    Extended viewing of movements of the intact hand in a mirror as well as motor imagery has been shown to decrease pain in phantom pain patients. We used functional magnetic resonance imaging to assess the neural correlates of mirrored, imagined and executed hand movements in 14 upper extremity amputees - 7 with phantom limb pain (PLP) and 7 without phantom limb pain (non-PLP) and 9 healthy controls (HC). Executed movement activated the contralateral sensorimotor area in all three groups but ipsilateral cortex was only activated in the non-PLP and HC group. Mirrored movements activated the sensorimotor cortex contralateral to the hand seen in the mirror in the non-PLP and the HC but not in the PLP. Imagined movement activated the supplementary motor area in all groups and the contralateral primary sensorimotor cortex in the non-PLP and HC but not in the PLP. Mirror- and movement-related activation in the bilateral sensorimotor cortex in the mirror movement condition and activation in the sensorimotor cortex ipsilateral to the moved hand in the executed movement condition were significantly negatively correlated with the magnitude of phantom limb pain in the amputee group. Further research must identify the causal mechanisms related to mirror treatment, imagined movements or movements of the other hand and associated changes in pain perception.

  4. Noninvasive Brain Stimulation, Maladaptive Plasticity, and Bayesian Analysis in Phantom Limb Pain.

    Science.gov (United States)

    Morales-Quezada, Leon

    2017-08-01

    Introduction: Phantom limb pain (PLP) is a common and poorly understood pathology of difficult medical control that progressively takes place after amputation occurs. Objective: This article discusses the multifactorial bases of PLP. These bases involve local changes at the stump level, spinal modifications of excitability, deafferentation, and central sensitization, leading to the development of maladaptive plasticity, and consequentially, defective processing of sensory information by associative neural networks. These changes can be traced by neurophysiology and imaging topographical studies, indicating a degree of cortical reorganization that perpetuates pain and discomfort. Intervention: Noninvasive brain stimulation can be an alternative way to manage PLP. This article discusses two techniques-transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS)-that have shown promising results for controlling PLP. The modulation that both techniques rely on is based on synaptic mechanisms linked to long-term potentiation and long-term depression phenomena. By applying tDCS or rTMS, clinicians can target processes associated with central sensitization and maladaptive plasticity, while promoting adequate sensory information processing by integrative cognitive behavioral techniques in a comprehensive rehabilitation program. Conclusions: Understanding PLP from a dynamic neurocomputational perspective will help to develop better treatments. Furthermore, Bayesian analysis of sensory information can help guide and monitor therapeutic interventions directed toward PLP resolution.

  5. Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report

    OpenAIRE

    Lee, Pil Moo; So, Yun; Park, Jung Min; Park, Chul Min; Kim, Hae Kyoung; Kim, Jae Hun

    2016-01-01

    Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management ...

  6. Perineural infusion of 0.5% ropivacaine for successful treatment of phantom limb syndrome: a case report.

    Science.gov (United States)

    Borghi, B; Bugamelli, S; Stagni, G; Missiroli, M; Genco, R; Colizza, M T

    2009-11-01

    Phantom limb syndrome (PLS) comprises various disturbances, including pain in the missing limb and phantom sensations. This study is about the successful treatment of a PLS patient by prolonged infusion of local anesthetic through a perineural catheter. A 45-year-old man came to the Rizzoli Orthopedic Institute (Bologna, Italy) complaining of a painful right leg after trauma. Complex regional pain syndrome (CRPS) type II was diagnosed. Therapy with tricyclics, gabapentin, and spinal infusion of morphine was started. After 4 years of treatment, infection led to the need for right below-the-knee amputation. After amputation, PLS appeared immediately and was not responsive to pharmacological treatment. At day II, a perineural sciatic catheter was positioned and 0.5% ropivacaine infusion with an elastomeric pump at 5 mL/h was started. The infusion was temporarily discontinued every week to evaluate the PLS. After 7 days, a 30% reduction in pain was observed, increased to 60% after 14 days, and disappeared completely after 21 days, leaving only the phantom limb sensations. After 28 days of continuous infusion, the phantom limb sensations had also disappeared. The perineural catheter was removed after 48 hours without perineural infusion. The patient was weaned from morphine over 150 days. Follow-ups at 6, 12, 24, and 36 months confirmed that the PLS did not reappear. The results are limited to one patient but are encouraging, particularly due to the relevance of the pathology and the poor results of conventional treatments. More cases are obviously needed to support the efficacy of this therapy.

  7. Édouard Manet's Tabes Dorsalis: From Painful Ataxia to Phantom Limb.

    Science.gov (United States)

    Bogousslavsky, Julien; Tatu, Laurent

    2016-01-01

    . Having become bedridden, he had to be amputated of one leg, which was developing gangrene probably associated with ergot overuse. While he died shortly thereafter, we have some witness anecdotes suggesting that he experienced a phantom limb: when Claude Monet (1840-1926) visited him and sat down on his bed, Manet violently shouted at him that he was just sitting on his (absent) leg, which provoked terrible pains. With its facts and mysteries, the subtle interaction between Manet's illness and his work output remains one of the most intriguing stories in neurology of art.

  8. Classification of non-weight bearing lower limb movements: towards a potential treatment for phantom limb pain based on myoelectric pattern recognition.

    Science.gov (United States)

    Lendaro, Eva; Ortiz-Catalan, Max

    2016-08-01

    Research in myoelectric pattern recognition (MPR) for the prediction of motor volition has primarily focused on the upper limbs. Recent studies in the lower limbs have mainly concentrated on prosthetic control, while MPR for lower limb rehabilitation purposes has received little attention. In this work we investigated the viability of a MPR system for the prediction of four degrees of freedom controlled in a near natural or physiologically appropriate fashion. We explored three different electrode configurations for acquiring electromyographic (EMG) signals: two targeted (bipolar and monopolar) and one untargeted (electrodes equally spaced axially). The targeted monopolar configuration yielded overall lower signal-to-noise ratios (SNR) but similar accuracy than those of the targeted bipolar configuration. The targeted bipolar and untargeted monopolar configurations were comparable in terms of SNR and offline accuracy when the same number of channels was used. However, the untargeted configuration tested with twice the channels yielded the best results in terms of accuracy. An advantage of the untargeted configuration is that it offers a simpler and more practical electrode placement. This work is the first step in our long-term goal of implementing a phantom limb pain (PLP) treatment for lower limb amputees based on MPR and augmented/virtual reality.

  9. A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees

    Directory of Open Access Journals (Sweden)

    Sacha B. Finn

    2017-07-01

    Full Text Available ObjectivePhantom limb pain (PLP is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees.MethodsFifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy (n = 9 or control (n = 6, covered mirror or mental visualization therapy. Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale.ResultsSubjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0 to 27.5 (SD = 17.2 mm (p = 0.002. In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673 to 448 (SD = 565 minutes (p = 0.003. By contrast, the control group had neither diminished pain (p = 0.65 nor decreased overall time experiencing pain (p = 0.49. A pain decrement response seen by the 10th treatment session was predictive of final efficacy.ConclusionThese results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes.RegistrationNCT0030144 ClinicalTrials.gov.

  10. Mirror Therapy for Phantom Limb Pain at a Pediatric Oncology Institution.

    Science.gov (United States)

    Anghelescu, Doralina L; Kelly, Cassandra N; Steen, Brenda D; Wu, Jianrong; Wu, Huiyun; DeFeo, Brian M; Scobey, Kristin; Burgoyne, Laura

    2016-07-01

    Mirror therapy has not been reported for phantom limb pain (PLP) in pediatric oncology. Our aims are to describe the incidence and duration of PLP post-amputation, the duration of follow-up, pain scores and pain medications, and the differences between a group that received mirror therapy (MT) in addition to the standard treatment and a group that received only the standard treatment (non-MT). A retrospective review of patients' medical records from June 2009 to March 2015 was completed. The demographic characteristics, diagnoses and types of surgery were collected. The incidence and duration of PLP, duration of pain service follow-up, pain medications and pain scores were collected and analyzed using the Wilcoxon rank sum test. Of 21 patients who underwent amputations (median age 13 years, range, 8-24 years), most common primary diagnosis osteosarcoma), 18 (85.7%) experienced PLP; 38.9% of them experienced PLP at 1 year post-amputation (11.1% of the MT group and 66.7% of the non-MT group). The MT group and non-MT groups experienced PLP for a mean (± SD) of 246 (± 200) days, and 541 (± 363) days, respectively (p=0.08). The mean (SD) opioid doses (mg/kg/day) in the MT and non-MT groups were 0.81 (± 0.99) and 0.33 (± 0.31), respectively; the mean (SD) gabapentin doses (mg/kg/day) were 40.1 (± 21) for the MT group and 30.5 (± 11.5) for the non-MT group. MT in children with cancer-related amputations is associated with lower incidence of PLP at 1 year and shorter duration of PLP.

  11. A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees.

    Science.gov (United States)

    Finn, Sacha B; Perry, Briana N; Clasing, Jay E; Walters, Lisa S; Jarzombek, Sandra L; Curran, Sean; Rouhanian, Minoo; Keszler, Mary S; Hussey-Andersen, Lindsay K; Weeks, Sharon R; Pasquina, Paul F; Tsao, Jack W

    2017-01-01

    Phantom limb pain (PLP) is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees. Fifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy (n = 9) or control (n = 6, covered mirror or mental visualization therapy). Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale. Subjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0) to 27.5 (SD = 17.2) mm (p = 0.002). In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673) to 448 (SD = 565) minutes (p = 0.003). By contrast, the control group had neither diminished pain (p = 0.65) nor decreased overall time experiencing pain (p = 0.49). A pain decrement response seen by the 10th treatment session was predictive of final efficacy. These results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes. NCT0030144 ClinicalTrials.gov.

  12. Virtual and augmented reality in the treatment of phantom limb pain: A literature review.

    Science.gov (United States)

    Dunn, Justin; Yeo, Elizabeth; Moghaddampour, Parisah; Chau, Brian; Humbert, Sarah

    2017-01-01

    Phantom limb pain (PLP), the perception of discomfort in a limb no longer present, commonly occurs following amputation. A variety of interventions have been employed for PLP, including mirror therapy. Virtual Reality (VR) and augmented reality (AR) mirror therapy treatments have also been utilized and have the potential to provide an even greater immersive experience for the amputee. However, there is not currently a consensus on the efficacy of VR and AR therapy. The aim of this review is to evaluate and summarize the current research on the effect of immersive VR and AR in the treatment of PLP. A comprehensive literature search was conducted utilizing PubMed and Google Scholar in order to collect all available studies concerning the use of VR and/or AR in the treatment of PLP using the search terms "virtual reality," "augmented reality," and "phantom limb pain." Eight studies in total were evaluated, with six of those reporting quantitative data and the other two reporting qualitative findings. All studies located were of low-level evidence. Each noted improved pain with VR and AR treatment for phantom limb pain, through quantitative or qualitative reporting. Additionally, adverse effects were limited only to simulator sickness occurring in one trial for one patient. Despite the positive findings, all of the studies were confined purely to case studies and case report series. No studies of higher evidence have been conducted, thus considerably limiting the strength of the findings. As such, the current use of VR and AR for PLP management, while attractive due to the increasing levels of immersion, customizable environments, and decreasing cost, is yet to be fully proven and continues to need further research with higher quality studies to fully explore its benefits.

  13. Phantom limb pain after amputation in diabetic patients does not differ from that after amputation in nondiabetic patients.

    Science.gov (United States)

    Clark, Roger L; Bowling, Frank L; Jepson, Fergus; Rajbhandari, Satyan

    2013-05-01

    There is a commonly held belief that diabetic amputees experience less phantom limb pain than nondiabetic amputees because of the effects of diabetic peripheral neuropathy; however, evidence to verify this claim is scarce. In this study, a customised postal questionnaire was used to examine the effects of diabetes on the prevalence, characteristics, and intensity of phantom limb pain (PLP) and phantom sensations (PS) in a representative group of lower-limb amputees. Participants were divided into those who had self-reported diabetes (DM group) and those who did not (ND group). Participants with diabetes were further divided into those with long-duration diabetes (>10years) and those with short-duration diabetes. Two hundred questionnaires were sent, from which 102 responses were received. The overall prevalence of PLP was 85.6% and there was no significant difference between the DM group (82.0%) and the ND group (89.4%) (P=0.391). There was also no difference in the prevalence of PS: DM group (66.0%), ND group (70.2%) (P=0.665). The characteristics of the pain were very similar in both groups, with sharp/stabbing pain being most common. Using a 0-10 visual analogue scale, the average intensity of PLP was 3.89 (±0.40) for the DM group and 4.38 (±0.41) for the ND group, which was not a statistically significant difference (P=0.402). Length of time since diagnosis of diabetes showed no correlation with average PLP intensity. Our findings suggest that there is no large difference in the prevalence, characteristics, or intensity of PLP when comparing diabetic and nondiabetic amputees, though a larger adjusted comparison would be valuable.

  14. [Changes in the somatosensory evoked potentials in patients with amputated limbs with and without phantom pain syndrome].

    Science.gov (United States)

    Reshetniak, V K; Kukushkin, M L; Ovechkin, A M; Smirnova, V S; Gnezdilov, A V

    1996-01-01

    Changes in the somatosensory evoked potentials (SSEP) were studied in patients with amputated limbs with and without phantom pain syndrome (PPS). Patients with PPS were found to develop hypersynchronous postdischarges following the components of SSEP, the amplitudes of the early components of SSEP (N1, P2, and N2) increase in response to stimulation of the stump nerves and the median nerve on the side of amputation, and EEG shows paroxysmal activity. The results indicate a stable increase of the excitability and reactivity of the central structures of the brain, reflecting the formation of a pathologic algic system in the structures regulating pain sensitivity.

  15. Treatment of phantom limb pain (PLP based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient

    Directory of Open Access Journals (Sweden)

    Max eOrtiz-Catalan

    2014-02-01

    Full Text Available A variety of treatments have been historically used to alleviate phantom limb pain (PLP with varying efficacy. Recently, virtual reality (VR has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR. Further, phantom motions are facilitated and encouraged through gaming.The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game.The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives.Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study.

  16. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient.

    Science.gov (United States)

    Ortiz-Catalan, Max; Sander, Nichlas; Kristoffersen, Morten B; Håkansson, Bo; Brånemark, Rickard

    2014-01-01

    A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR). Further, phantom motions are facilitated and encouraged through gaming. The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy) for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game. The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb, and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives. Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study.

  17. ‘It’s All Done With Mirrors’: V.S. Ramachandran and the Material Culture of Phantom Limb Research

    Science.gov (United States)

    Guenther, Katja

    2016-01-01

    This article examines the material culture of neuroscientist Vilayanur S. Ramachandran’s research into phantom limbs. In the 1990s Ramachandran used a ‘mirror box’ to ‘resurrect’ phantom limbs and thus to treat the pain that often accompanied them. The experimental success of his mirror therapy led Ramachandran to see mirrors as a useful model of brain function, a tendency that explains his attraction to work on ‘mirror neurons’. I argue that Ramachandran’s fascination with and repeated appeal to the mirror can be explained by the way it allowed him to confront a perennial problem in the mind and brain sciences, that of the relationship between a supposedly immaterial mind and a material brain. By producing what Ramachandran called a ‘virtual reality’, relating in varied and complex ways to the material world, the mirror reproduced a form of psycho-physical parallelism and dualistic ontology, while conforming to the materialist norms of neuroscience today. PMID:27292324

  18. Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report.

    Science.gov (United States)

    Lee, Pil Moo; So, Yun; Park, Jung Min; Park, Chul Min; Kim, Hae Kyoung; Kim, Jae Hun

    2016-04-01

    Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

  19. Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence-based Practice Approach.

    Science.gov (United States)

    Rothgangel, Andreas; Braun, Susy; de Witte, Luc; Beurskens, Anna; Smeets, Rob

    2016-04-01

    To describe the development and content of a clinical framework for mirror therapy (MT) in patients with phantom limb pain (PLP) following amputation. Based on an a priori formulated theoretical model, 3 sources of data collection were used to develop the clinical framework. First, a review of the literature took place on important clinical aspects and the evidence on the effectiveness of MT in patients with phantom limb pain. In addition, questionnaires and semi-structured interviews were used to analyze clinical experiences and preferences of physical and occupational therapists and patients suffering from PLP regarding the application of MT. All data were finally clustered into main and subcategories and were used to complement and refine the theoretical model. For every main category of the a priori formulated theoretical model, several subcategories emerged from the literature search, patient, and therapist interviews. Based on these categories, we developed a clinical flowchart that incorporates the main and subcategories in a logical way according to the phases in methodical intervention defined by the Royal Dutch Society for Physical Therapy. In addition, we developed a comprehensive booklet that illustrates the individual steps of the clinical flowchart. In this study, a structured clinical framework for the application of MT in patients with PLP was developed. This framework is currently being tested for its effectiveness in a multicenter randomized controlled trial. © 2015 World Institute of Pain.

  20. Phantom pain and health-related quality of life in lower limb amputees

    NARCIS (Netherlands)

    van der Schans, CP; Geertzen, JHB; Schoppen, T; Dijkstra, PU

    2002-01-01

    Amputation of a limb may affect quality of life. However, little is known concerning health-related quality of life in amputees. The purposes of this study were to describe health-related quality of life in a population of lower limb amputees and to investigate potential determinants, including

  1. Phantom pain and health-related quality of life in lower limb amputees

    NARCIS (Netherlands)

    van der Schans, CP; Geertzen, JHB; Schoppen, T; Dijkstra, PU

    2002-01-01

    Amputation of a limb may affect quality of life. However, little is known concerning health-related quality of life in amputees. The purposes of this study were to describe health-related quality of life in a population of lower limb amputees and to investigate potential determinants, including phan

  2. [A clinical and experimental study of the role of long-lasting perioperative epidural anesthesia in the prevention of phantom limb pain].

    Science.gov (United States)

    Ovechkin, A M; Kukushkin, M L; Gnezdilov, A V; Reshetniak, V K

    1994-01-01

    The aim of this study was to investigate the possible onset of phantom limb pain (PLP) and its development depending on preoperative limb pain and type of anesthesia during limb amputation. It was experimentally proved that preliminary local anesthesia of rat sciatic nerve slowed down the development of pain syndrome after the operation as well as reduced the number of rats with pain syndrome, as compared to the group subjected to preliminary painful electrical stimulation of the operated on limb. The clinical data presented reveal a significant reduction in the incidence of PLP after perioperative epidural anesthesia, as compared to patients with preoperative pain operated on under general anesthesia.

  3. Management of supernumerary teeth

    Directory of Open Access Journals (Sweden)

    Abhishek Parolia

    2011-01-01

    Full Text Available Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. This article reviews the etiology, frequency, classification, complications, diagnosis and management of supernumerary teeth (bilateral maxillary paramolars

  4. Intracranial supernumerary tooth

    Energy Technology Data Exchange (ETDEWEB)

    Sjoeberg, S.; Loerinc, P.

    1984-12-01

    Case report of an accidentally diagnosed supernumerary tooth in the superior orbital fissure. Computed tomography (CT) contributed with a more precise localization of the tooth being situated between the orbit and the brain. CT also showed that there was no cyst or other pathological process around the supernumerary tooth, which is plausible and frequently reported in the literature.

  5. Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach.

    Science.gov (United States)

    Rothgangel, Andreas; Braun, Susy; Smeets, Rob; Beurskens, Anna

    2017-02-15

    Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients' adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain. The main aim of this study was to describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain. We addressed 3 research questions: (1) Which requirements are defined by patients and therapists for the content and functions of a telerehabilitation platform and how can these requirements be prioritized to develop a first prototype of the platform? (2) How can the user interface of the telerehabilitation platform be designed so as to match the predefined critical user requirements and how can this interface be translated into a medium-fidelity prototype of the platform? (3) How do patients with phantom limb pain and their treating therapists judge the usability of the medium-fidelity prototype of the telerehabilitation platform in routine care and how can the platform be redesigned based on their feedback to achieve a high-fidelity prototype? The telerehabilitation platform was developed using an iterative user-centered design process. In the first phase, a questionnaire followed by a semistructured interview was used to identify the user requirements of both the patients and their physical and occupational therapists, which were then prioritized using a decision matrix. The second phase involved designing the interface of the telerehabilitation platform using design sketches, wireframes, and interface mock-ups to develop a low-fidelity prototype. Heuristic evaluation resulted in a medium

  6. Inter-individual difference in the effect of mirror reflection-induced visual feedback on phantom limb awareness in forearm amputees.

    Directory of Open Access Journals (Sweden)

    Noritaka Kawashima

    Full Text Available OBJECTIVE: To test whether the phantom limb awareness could be altered by observing mirror reflection-induced visual feedback (MVF in unilateral forearm amputees. METHODS: Ten unilateral forearm amputees were asked to perform bilateral (intact and phantom synchronous wrist motions with and without MVF. During wrist motion, electromyographic activities in the extensor digitorum longus (EDL and flexor carpi radialis muscles (FCR were recorded with bipolar electrodes. Degree of wrist range of motion (ROM was also recorded by electrogoniometry attached to the wrist joint of intact side. Subjects were asked to answer the degree of attainment of phantom limb motion using a visual analog scale (VAS: ranging from 0 (hard to 10 (easy. RESULTS: VAS and ROM were significantly increased by utilizing MVF, and the extent of an enhancement of the VAS and wrist ROM was positively correlated (r = 0.72, p<0.05. Although FCR EMG activity also showed significant enhancement by MVF, this was not correlated with the changes of VAS and ROM. Interestingly, while we found negative correlation between EDL EMG activity and wrist ROM, MVF generally affected to be increasing both EDL EMG and ROM. CONCLUSIONS: Although there was larger extent of variability in the effect of MVF on phantom limb awareness, MVF has a potential to enhance phantom limb awareness, in case those who has a difficulty for the phantom limb motion. The present result suggests that the motor command to the missing limb can be re-activated by an appropriate therapeutic strategy such as mirror therapy.

  7. Left is where the L is right. Significantly delayed reaction time in limb laterality recognition in both CRPS and phantom limb pain patients.

    Science.gov (United States)

    Reinersmann, Annika; Haarmeyer, Golo Sung; Blankenburg, Markus; Frettlöh, Jule; Krumova, Elena K; Ocklenburg, Sebastian; Maier, Christoph

    2010-12-17

    The body schema is based on an intact cortical body representation. Its disruption is indicated by delayed reaction times (RT) and high error rates when deciding on the laterality of a pictured hand in a limb laterality recognition task. Similarities in both cortical reorganisation and disrupted body schema have been found in two different unilateral pain syndromes, one with deafferentation (phantom limb pain, PLP) and one with pain-induced dysfunction (complex regional pain syndrome, CRPS). This study aims to compare the extent of impaired laterality recognition in these two groups. Performance on a test battery for attentional performance (TAP 2.0) and on a limb laterality recognition task was evaluated in CRPS (n=12), PLP (n=12) and healthy subjects (n=38). Differences between recognising affected and unaffected hands were analysed. CRPS patients and healthy subjects additionally completed a four-day training of limb laterality recognition. Reaction time was significantly delayed in both CRPS (2278±735.7ms) and PLP (2301.3±809.3ms) compared to healthy subjects (1826.5±517.0ms), despite normal TAP values in all groups. There were no differences between recognition of affected and unaffected hands in both patient groups. Both healthy subjects and CRPS patients improved during training, but RTs of CRPS patients (1874.5±613.3ms) remain slower (p<0.01) than those of healthy subjects (1280.6±343.2ms) after four-day training. Despite different pathomechanisms, the body schema is equally disrupted in PLP and CRPS patients, uninfluenced by attention and pain and cannot be fully reversed by training alone. This suggests the involvement of complex central nervous system mechanisms in the disruption of the body schema.

  8. Cases of Phantom Limb Pain were Cured by Acupuncturing "Sitan Points "%针刺四天穴治疗幻肢痛验案

    Institute of Scientific and Technical Information of China (English)

    蒋荣民; 曲由

    2012-01-01

    With the increase in amputees, phantom limb pain patients have increased the number of patients under the action of various factors. The method of acupuncturing "Stian Points" for phantom limb pain is significant effect, it's simple and worthy of promotion.%各种因素下,随着截肢患者的增多,幻肢痛患者的人数也随之增加.针刺“四天穴”治疗幻肢痛疗效显著,简便易行,值得推广.

  9. Phantom Pain

    NARCIS (Netherlands)

    Wolff, Andre; Vanduynhoven, Eric; van Kleef, Maarten; Huygen, Frank; Pope, Jason E.; Mekhail, Nagy

    2011-01-01

    Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation. The reported incidence of phantom limb pain after trauma, injury or peripheral vascular diseases is 60% to 80%. Over half the p

  10. Abnormal thalamocortical dynamics may be altered by deep brain stimulation: using magnetoencephalography to study phantom limb pain.

    Science.gov (United States)

    Ray, N J; Jenkinson, N; Kringelbach, M L; Hansen, P C; Pereira, E A; Brittain, J S; Holland, P; Holliday, I E; Owen, S; Stein, J; Aziz, T

    2009-01-01

    Deep brain stimulation (DBS) is used to alleviate chronic pain. Using magnetoencephalography (MEG) to study the mechanisms of DBS for pain is difficult because of the artefact caused by the stimulator. We were able to record activity over the occipital lobe of a patient using DBS for phantom limb pain during presentation of a visual stimulus. This demonstrates that MEG can be used to study patients undergoing DBS provided control stimuli are used to check the reliability of the data. We then asked the patient to rate his pain during and off DBS. Correlations were found between these ratings and power in theta (6-9) and beta bands (12-30). Further, there was a tendency for frequencies under 25 Hz to correlate with each other after a period off stimulation compared with immediately after DBS. The results are interpreted as reflecting abnormal thalamocortical dynamics, previously implicated in painful syndromes.

  11. The PACT trial: PAtient Centered Telerehabilitation: effectiveness of software-supported and traditional mirror therapy in patients with phantom limb pain following lower limb amputation: protocol of a multicentre randomised controlled trial.

    Science.gov (United States)

    Rothgangel, Andreas Stefan; Braun, Susy; Schulz, Ralf Joachim; Kraemer, Matthias; de Witte, Luc; Beurskens, Anna; Smeets, Rob Johannes

    2015-01-01

    Non-pharmacological interventions such as mirror therapy are gaining increased recognition in the treatment of phantom limb pain; however, the evidence in people with phantom limb pain is still weak. In addition, compliance to self-delivered exercises is generally low. The aim of this randomised controlled study is to investigate the effectiveness of mirror therapy supported by telerehabilitation on the intensity, duration and frequency of phantom limb pain and limitations in daily activities compared to traditional mirror therapy and care as usual in people following lower limb amputation. A three-arm multi-centre randomised controlled trial will be performed. Participants will be randomly assigned to care as usual, traditional mirror therapy or mirror therapy supported by telerehabilitation. During the first 4 weeks, at least 10 individual sessions will take place in every group. After the first 4 weeks, participants will be encouraged to perform self-delivered exercises over a period of 6 weeks. Outcomes will be assessed at 4 and 10 weeks after baseline and at 6 months follow-up. The primary outcome measure is the average intensity of phantom limb pain during the last week. Secondary outcome measures include the different dimensions of phantom limb pain, pain-related limitations in daily activities, global perceived effect, pain-specific self-efficacy, and quality of life. Several questions concerning the study design that emerged during the preparation of this trial will be discussed. This will include how these questions were addressed and arguments for the choices that were made. Copyright © 2014 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

  12. Supernumerary teeth in clinical practice

    Directory of Open Access Journals (Sweden)

    Anna K. Szkaradkiewicz

    2011-07-01

    Full Text Available Introduction: Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. The prevalence rates of supernumerary teeth in the permanent dentition amounts 0.1-6.9%, and in deciduous dentition 0.4-0.8%. The presence of supernumerary teeth can be found in everyday dental practice.Case presentation: We describe 3 cases of patients with supernumerary teeth. First patient had supernumerary lateral incisor 12s, second - premolar fused, multicuspid, supernumerary deciduous tooth 64s of having several interconnected roots, and third - erupted odontoma between teeth 13 and 14. In all cases treatment involved the removal of the supernumerary tooth.Conclusions: The decision on proceeding with the supernumerary teeth should be based on the full clinical picture and interview. Early diagnosis and removal of supernumerary teeth allow to avoid or reduce possible complications.

  13. The Torments of Spring: Jake Barnes's Phantom Limb in The Sun Also Rises.

    Science.gov (United States)

    Anesko, Michael

    2015-01-01

    While critics recently have found The Sun Also Rises a fruitful text for reexamining issues of gender and sexuality in Hemingway's work, a significant aspect of Jake Barnes's genital wounding has been overlooked. At least from the time of the American Civil War, a diverse body of medical literature has documented the psychosomatic reality of phantom genitalia in traumatically injured men. Revisiting the novel from this perspective-imagining that Jake Barnes is haunted by a penile ghost-allows us to see this character as something more than a victim of disability. Instead, we might think of Jake's material self as figuratively masculine but accidentally transgendered: a body that others can desire and that still can choose, or not, to reciprocate sexual feeling.

  14. 'You don't need a body to feel a body': phantom limb syndrome and corporeal transgression.

    Science.gov (United States)

    Crawford, Cassandra S

    2013-03-01

    One of the central tensions within the literature on body studies concerns the degree to which the physical body is constituted by or through language, knowledges, and practices and the degree to which the body has foundational, purely material, or essential attributes. Three theoretical approaches have been at the heart of this debate: social constructionism, phenomenology, and structuration theory. Recently, body studies theorists have challenged scholars to move beyond the widely recognised limitations of dominant theorising by taking into account all three perspectives and conceptualising the body as surface, vehicle, and circuit. Because they embrace agnosticism and relational materialism, science and technology studies scholars are in a distinctive position to answer this call. Proponents fully acknowledge the materiality of the body without espousing essentialist claims by effacing the analytic division between agency and structure. Starting from this perspective, I use the concept of corporeal transgression and the phenomenon of phantom limb to reveal how 'immaterial'--indeed, at times, fictive and fanciful--body parts became socially and materially substantive, engendering transformations within the bodies, minds, and brains of amputees, as well as within the field of neuroscience.

  15. Miembro fantasma y otras trastornos del esquema corporal Phantom limb and other alterations of the corporal scheme

    Directory of Open Access Journals (Sweden)

    Francisco Lopera Restrepo

    1995-03-01

    Full Text Available

    Se hace una revisión sobre los fenómenos de miembro, sensación y dolor fantasmas que se presentan en pacientes con pérdida súbita de una porción de la estructura corporal. Estos fenómenos fantasmas sugieren la existencia de una representación cerebral del cuerpo que se construye a nivel cortical con ayuda de las experiencias vividas por el sujeto en relación con su propio cuerpo. La existencia de una representación cerebral compleja del propio cuerpo se relaciona con una variada semiología de trastornos del esquema corporal que puede ser detectada en las clínicas neuropsicológica y neuropsiquiátrica.

    A review is presented on the phantom phenomena (limb, sensation and pain, that appear in patients with sudden loss of a portion of the corporal structure. These phenomena suggest the existence of a brain representation of the body, built at the cortical level partially as a result of previous experiences with ones own body. Alterations of the brain's corporal scheme give rise to rich neuropsychological and neuropsychiatric manifestations.

  16. Progress on nursing care of phantom limb pain%幻肢痛的护理进展

    Institute of Scientific and Technical Information of China (English)

    王会利

    2011-01-01

    @@ 幻肢痛(phantom limb pain, PLP)是主观感觉已被截除的肢体仍然存在并有不同程度、不同性质疼痛的现象.幻肢痛是截肢患者术后常见的并发症,发生率50%~80%.幻肢痛首次发作通常在截肢后早期,一些研究显示75%患者截肢后数天就可出现幻肢痛,但也有少数患者在截肢后数月或数年后才开始出现.Sheman等[1]研究发现,幻肢痛患者中45%日常活动受到影响,33.5%工作能力受到影响,18%工作能力丧失,43%社会能力降低,82%存在严重程度不等的失眠现象.其疼痛的特点主要为跳痛、刺痛、钻孔样痛、挤压痛、灼痛、拧痛,有时伴头、背等其他部位疼痛,并呈阵发性加重[2].

  17. Anxiety and depression in patients with amputated limbs suffering from phantom pain: A comparative study with non-phantom chronic pain

    Directory of Open Access Journals (Sweden)

    Hadi Kazemi

    2013-01-01

    Conclusion : Our results indicate that depression and anxiety are not more common in PLP patients, whereas they are more prevalent in subjects with non-phantom chronic pain. These lower levels of anxiety and depression in PLP compared with chronic pain is a new finding that needs to be evaluated further, which may lead to new insights into the pathogenesis of phantom pain in further studies.

  18. Supernumerary Teeth in Nepalese Children

    Directory of Open Access Journals (Sweden)

    Varun Pratap Singh

    2014-01-01

    Full Text Available Objective. The objectives of the present study were to investigate the prevalence and characteristics of supernumerary teeth in a patient sample of Nepalese children. Study Design. A survey was performed on 2684 patients (1829 females and 1035 males ranging in age from 6 to 14 for the presence of supernumerary teeth. For each patient with supernumerary teeth the demographic variables (age and sex, number, location, eruption status, and morphology were recorded. Descriptive statistics were performed. Results. Supernumerary teeth were detected in 46 subjects (1.6%, of which 26 were males and 20 were females with a male : female ratio of 1.3 : 1. The most commonly found supernumerary tooth was mesiodens followed by maxillary premolars, maxillary lateral incisor, and mandibular lateral incisor. Of the 55 supernumerary teeth examined, 58.18% (n=32 had conical morphology, followed by tuberculate (30.90%, n=17 and supplemental (10.90%, n=6 forms. The majority of the supernumerary teeth were erupted (56.36%, n=31. Conclusion. The prevalence of supernumerary teeth in Nepalese children was found to be 1.6%, the most frequent type being mesiodens. Conical morphology was found to be the most common form of supernumerary tooth.

  19. Supernumerary teeth in Nepalese children.

    Science.gov (United States)

    Singh, Varun Pratap; Sharma, Amita; Sharma, Sonam

    2014-01-01

    The objectives of the present study were to investigate the prevalence and characteristics of supernumerary teeth in a patient sample of Nepalese children. A survey was performed on 2684 patients (1829 females and 1035 males) ranging in age from 6 to 14 for the presence of supernumerary teeth. For each patient with supernumerary teeth the demographic variables (age and sex), number, location, eruption status, and morphology were recorded. Descriptive statistics were performed. Supernumerary teeth were detected in 46 subjects (1.6%), of which 26 were males and 20 were females with a male : female ratio of 1.3 : 1. The most commonly found supernumerary tooth was mesiodens followed by maxillary premolars, maxillary lateral incisor, and mandibular lateral incisor. Of the 55 supernumerary teeth examined, 58.18% (n = 32) had conical morphology, followed by tuberculate (30.90%, n = 17) and supplemental (10.90%, n = 6) forms. The majority of the supernumerary teeth were erupted (56.36%, n = 31). The prevalence of supernumerary teeth in Nepalese children was found to be 1.6%, the most frequent type being mesiodens. Conical morphology was found to be the most common form of supernumerary tooth.

  20. Managing phantom pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay

    2004-07-01

    Since the first medical description of post-amputation phenomena reported by Ambrose Paré, persistent phantom pain syndromes have been well recognized. However, they continue to be difficult to manage. The three most commonly utilized terms include phantom sensation, phantom pain, and stump pain. Phantom limb sensation is an almost universal occurrence at some time during the first month following surgery. However, most phantom sensations generally resolve after two to three years without treatment, except in the cases where phantom pain develops. The incidence of phantom limb pain has been reported to vary from 0% to 88%. The incidence of phantom limb pain increases with more proximal amputations. Even though phantom pain may diminish with time and eventually fade away, it has been shown that even two years after amputation, the incidence is almost the same as at onset. Consequently, almost 60% of patients continue to have phantom limb pain after one year. In addition, phantom limb pain may also be associated with multiple pain problems in other areas of the body. The third symptom, stump pain, is located in the stump itself. The etiology and pathophysiological mechanisms of phantom pain are not clearly defined. However, both peripheral and central neural mechanisms have been described, along with superimposed psychological mechanisms. Literature describing the management of phantom limb pain or stump pain is in its infancy. While numerous treatments have been described, there is little clinical evidence supporting drug therapy, psychological therapy, interventional techniques or surgery. This review will describe epidemiology, etiology and pathophysiological mechanisms, risk factors, and treatment modalities. The review also examines the effectiveness of various described modalities for prevention, as well as management of established phantom pain syndromes.

  1. Supernumerary Jawbone Tooth: Clinical Case

    OpenAIRE

    Rivas Gutiérrez, Jesús; Carlos Sánchez, María Dolores

    2016-01-01

    Introduction: supernumerary teeth are dental development anomalies, alsoknown as hyperdontia or extra teeth. Their prevalence ranges between 0.3% and 3.8%.Their morphology may be normal or dismorphic and are associated to the etiology ofocclusal alterations. It is important to make an early diagnostic through a radiographicalstudy. Case presentation:this article presents a clinical case of a supernumerary tooth thatcaused rotation and crowding of the anterior bottom teeth, which was addressed...

  2. 幻肢痛病理机制研究进展%The Research Advances of the Pathomechanism of Phantom Limb Pain (PLP)

    Institute of Scientific and Technical Information of China (English)

    靳晴晴; 唐丹丹; 彭微微; 胡理

    2015-01-01

    Phantom limb pain (PLP)is a hallucination that the patient feels the existence of the limb af-ter its loss and experiences somewhat pain of the missing limb.Such a pain normally appears in the distal end of the missing limb.Currently,the pathomechanism of PLP is still unclear,and the clinical research of PLP mainly relies on the subjective report of the patients and the psychophysical measurements.In this paper,we discuss extensively the pathomechanism of PLP,and summarize comprehensively the advanced methods for studying the pathomechanism of PLP.In short,the paper could deepen our understanding of the pathomechanism of PLP,and could serve as an effective instruction basis for researchers and doctors to diagnose and treat the PLP.%幻肢痛即肢幻觉痛,指主观感觉已被截除的肢体仍然存在,并且伴有一定程度的疼痛,这类疼痛多出现在断肢的远端。目前幻肢痛的病理机制尚不明确,其临床研究主要依赖于患者的主观报告与心理物理测量。本文详述了幻肢痛的可能病理机制,并系统总结了研究幻肢痛病理机制的方法。总体来说,本文既能加深我们对幻肢痛病理机制的认识,也能为科研工作者和医护人员的临床诊断和治疗提供有效的参考依据。

  3. ESQUISSE D’UNE PHÉNOMÉNOLOGIE DES FANTÔMES. VERS UNE NOUVELLE CONCEPTION DU RÉEL À PARTIR DE L’ANALYSE MERLEAU-PONTYENNE DU MEMBRE FANTÔME (Outline of a phenomenology of phantoms. Towards a new conception of the real through Merleau–Ponty’s analysis of the phantom-limb

    Directory of Open Access Journals (Sweden)

    Annabelle Dufourcq

    2015-06-01

    Full Text Available This article is an introduction to the study of the close connection between phenomenology and the investigations on phantoms. We want to show that there is a deep kinship between phenomena and phantoms and that Husserl’s phenomenological project, as well as, more specifically, its original reinstitution by Merleau-Ponty, lead us to think the real on the basis of a reference to phantoms regarded as ontological models. Our analyses will be based more precisely on Merleau-Ponty’s study of the phantom-limb in Phenomenology of Perception. We will contend that the body itself, through the concepts of body schema and of structure [Gestalt], is eventually thought of by Merleau-Ponty as possessing the same mode of being as phantoms.

  4. Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report

    Science.gov (United States)

    Lee, Jong-Hoo; Byun, Jeong-Hyun; Choe, Yu-Ri; Lim, Seung-Kyu; Lee, Ka-Young

    2015-01-01

    A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere. PMID:26361601

  5. 21. Phantom pain.

    NARCIS (Netherlands)

    Wolff, A.P.; Vanduynhoven, E.; Kleef, M. van; Huygen, F.; Pope, J.E.; Mekhail, N.

    2011-01-01

    Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation. The reported incidence of phantom limb pain after trauma, injury or peripheral vascular diseases is 60% to 80%. Over half the p

  6. Supernumerary teeth "mesiodens". Case report.

    Science.gov (United States)

    Itro, A; Difalco, P

    2003-09-01

    The supernumerary tooth is an anomaly of dental eruption that is not rare to find in the clinical practice. Among the supernumerary teeth the "mesiodens" is most frequent. The mesiodens is found in the region of the superior central incisors and it can be the cause of many complications. The aim of this work is the description of a rare symptomatic case of mesiodens and the diagnostic and therapeutic strategies to adopt when this dental anomaly occurs. In particular the authors suggest making radiographic examinations only in the family of patients with dental anomalies of number, thinking that the incidence of such anomalies is too low to justify mass radiographic examinations.

  7. Late Developing Supernumeraries in a Case of Nonsyndromic Multiple Supernumerary Teeth

    Directory of Open Access Journals (Sweden)

    Mine Bozkurt

    2015-01-01

    Full Text Available Objective. This case report presents 3-year follow-up of a case of nonsyndromic multiple supernumerary teeth (NSMST with 11 supernumerary teeth, 2 of which showed subsequent formation. Case Report. A 10-year-old girl was referred to the dental clinic with the chief complaint of delayed eruption. Radiographic examination showed 9 retained supernumerary teeth. The treatment plan consisted of extraction of the supernumerary teeth and associated primary teeth in order to allow the permanent teeth to erupt. After 2 years of follow-up, 2 additional supernumerary teeth were observed. Conclusion. Regular follow-up for late forming supernumeraries is crucial for NSMST cases.

  8. 幻肢痛的临床治疗进展%Advances in Clinical Treatment of Phantom Limb Pain

    Institute of Scientific and Technical Information of China (English)

    黄兵

    2011-01-01

    Phantom Jimb pain (PLP ) is one of the major complications of amputation. Along with the deepening of the PLF pathophysiology of the disease, more progress is achieved in the treatment as well. The latest treatments include medication , nerve block , psychological and behavioral therapy,physical rehabilitation therapy,surgical therapy and the patient care. Multidisciplinary approaches are very important for the treatment , especially the psychobehavioral , rehabilitation and operative therapy . But there is still no consensus or guidelines about treatment of PLP and laree-sample studies are still needed.%幻肢痛是截肢后常见的并发症之一.随着对幻肢痛病理生理机制研究的不断深入,幻肢痛的治疗有了较多进展.最新的治疗方法包括药物治疗、神经阻滞、心理行为疗法、物理康复疗法、手术疗法、患者护理等.幻肢痛的治疗以多学科综合治疗为主,尤其应重视对心理行为、康复治疗和手术治疗的研究.但目前还没有关于幻肢痛治疗的共识或指南,尚需作大样本研究.

  9. Optimizing Rehabilitation for Phantom Limb Pain Using Mirror Therapy and Transcranial Direct Current Stimulation: A Randomized, Double-Blind Clinical Trial Study Protocol.

    Science.gov (United States)

    Pinto, Camila Bonin; Saleh Velez, Faddi Ghassan; Bolognini, Nadia; Crandell, David; Merabet, Lotfi B; Fregni, Felipe

    2016-07-06

    Despite the multiple available pharmacological and behavioral therapies for the management of chronic phantom limb pain (PLP) in lower limb amputees, treatment for this condition is still a major challenge and the results are mixed. Given that PLP is associated with maladaptive brain plasticity, interventions that promote cortical reorganization such as non-invasive brain stimulation and behavioral methods including transcranial direct current stimulation (tDCS) and mirror therapy (MT), respectively, may prove to be beneficial to control pain in PLP. Due to its complementary effects, a combination of tDCS and MT may result in synergistic effects in PLP. The objective of this study is to evaluate the efficacy of tDCS and MT as a rehabilitative tool for the management of PLP in unilateral lower limb amputees. A prospective, randomized, placebo-controlled, double-blind, factorial, superiority clinical trial will be carried out. Participants will be eligible if they meet the following inclusion criteria: lower limb unilateral traumatic amputees that present PLP for at least 3 months after the amputated limb has completely healed. Participants (N=132) will be randomly allocated to the following groups: (1) active tDCS and active MT, (2) sham tDCS and active MT, (3) active tDCS and sham MT, and (4) sham tDCS and sham MT. tDCS will be applied with the anodal electrode placed over the primary motor cortex (M1) contralateral to the amputation side and the cathode over the contralateral supraorbital area. Stimulation will be applied at the same time of the MT protocol with the parameters 2 mA for 20 minutes. Pain outcome assessments will be performed at baseline, before and after each intervention session, at the end of MT, and in 2 follow-up visits. In order to assess cortical reorganization and correlate with clinical outcomes, participants will undergo functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) before and after the

  10. "Phantom" carpal tunnel syndrome.

    Science.gov (United States)

    Braverman, D L; Root, B C

    1997-10-01

    Phantom sensation is ubiquitous among persons who have had amputation; however, if it develops into phantom pain, a thorough clinical investigation must ensue. We illustrate this with the case of a 49-year-old woman, 14 years after traumatic amputation of her left 2nd through 5th fingers, and 10 years after traumatic left transfemoral amputation. She had had phantom sensation in her absent fingers for years and developed progressive pain in her phantom fingers 3 months before presentation. Nerve conduction study revealed a high-normal distal motor latency of the left median nerve and a positive Bactrian test (sensitivity 87%). She was diagnosed with "phantom" carpal tunnel syndrome and treated with a resting wrist splint, decreased weight bearing on the left upper limb, and two corticosteroid carpal tunnel injections with marked improvement. Clinicians should recognize that phantom pain may be referred from a more proximal region and may be amenable to conservative management.

  11. Supernumerary teeth in non-syndromic patients

    Energy Technology Data Exchange (ETDEWEB)

    Mali, Santosh; Karjodkar, Freny Rashmiraj; Sontakke, Subodh; Sansare, Kaustubh [Nair Hospital Dental College, Maharashtra (India)

    2012-03-15

    Hyperdontia or supernumerary teeth without associated syndrome is a rare phenomenon, as supernumerary teeth are usually associated with cleft lip and palate or other syndromes such as Gardner's syndrome, cleidocranial dysplasia, and so on. Five patients with supernumerary teeth visited our department. They had no familial history or other pathology, certain treatment protocols was modified due to the presence of supernumerary teeth. Non-syndromic supernumerary teeth, if asymptomatic, need to have periodical radiographic observation. If they showed no variation as they impacted in the jaw, careful examination is necessary because they may develop into pathological status such as dentigerous cysts. The importance of a precise clinical history and radiographic examination for patients with multiple supernumerary teeth should be emphasized.

  12. Late Developing Supernumeraries in a Case of Nonsyndromic Multiple Supernumerary Teeth

    OpenAIRE

    Mine Bozkurt; Tugba Bezgin; Ayşegül Tüzüner Öncül; Rukiye Göçer; Şaziye Sarı

    2015-01-01

    Objective. This case report presents 3-year follow-up of a case of nonsyndromic multiple supernumerary teeth (NSMST) with 11 supernumerary teeth, 2 of which showed subsequent formation. Case Report. A 10-year-old girl was referred to the dental clinic with the chief complaint of delayed eruption. Radiographic examination showed 9 retained supernumerary teeth. The treatment plan consisted of extraction of the supernumerary teeth and associated primary teeth in order to allow the permanent tee...

  13. Fibroadenoma in axillary supernumerary breast: case report

    OpenAIRE

    Délio Marques Conde; Renato Zocchio Torresan; Eiji Kashimoto; Luiz Eduardo Campos de Carvalho; Cássio Cardoso Filho

    2005-01-01

    CONTEXT: Supernumerary breast tissue may be affected by the same diseases and alterations that compromise topical breast tissue. Nevertheless, reports of fibroadenoma in supernumerary breast tissue in the axillae are rare. OBJECTIVE: To describe a case of fibroadenoma in an axillary supernumerary breast. DESIGN: Case report. CASE REPORT: A 39-year-old woman was referred to the gynecology and obstetrics outpatient clinic at Hospital Estadual Sumaré, complaining of bilateral axillary masses. Th...

  14. Sensación de miembro fantasma y dolor de miembro residual tras 50 años de la amputación Chronic phantom sensation and residual limb pain 50 years after amputation

    Directory of Open Access Journals (Sweden)

    J. Olarra

    2007-08-01

    Full Text Available Introducción El dolor del miembro residual o dolor de muñón es aquel que aparece en la parte todavía existente de la extremidad amputada. Paciente: Presentamos el caso de un paciente varón de 74 años con antecedentes de amputación supracondílea postraumática del miembro inferior izquierdo, que desarrolló dolor de miembro residual y sensación de miembro fantasma 50 años después de la amputación sin una causa que Justificara su aparición. El tratamiento con antidepresivos tricíclicos (amitriptilina, anticonvulsivantes (gabapentina y tramadol permitió un buen control del dolor. Conclusiones: La existencia de una matriz neuronal determinada genéticamente pero modulada durante la vida por los impulsos nerviosos (nociceptivos, crearía una memoria somato-sensorial que sería responsable de la aparición del dolor de miembro fantasma.Background and objective: Residual limb pain or stump pain is defined as pain in the remaining part of an amputated limb. Patient: We present the case of a 74-year-old male patient with a history of posttraumatic transfemoral (above knee amputation of the left lower limb who developed residual limb pain and phantom limb sensation 50 years after amputation without a clear etiology. Treatment with tricyclic antidepressants (amitriptyline, anticonvulsivants (gabapentin and opioids (tramadol, provided a satisfactory control of pain. Conclusions: The existence of a neuromatrix initially determined genetically and later sculpted by sensory inputs (continuous nociceptive stimulation, could create what is known as the somatosensorial memory, responsible for the development of phantom limb pain.

  15. Phantom limb pain relieved with different modalities of central nervous system stimulation: a clinical and functional imaging case report of two patients.

    Science.gov (United States)

    Nandi, Dipankar; Yianni, John; Humphreys, Joanna; Wang, Shouyan; O'sullivan, Valerie; Shepstone, Basil; Stein, John F; Aziz, Tipu Z

    2004-07-01

    Phantom limb pain (PLP) is a type of neuropathic pain syndrome that has evoked much interest in scientific and clinical fields. The condition is often intractable and severely debilitating. Though there are anecdotal reports in the literature of successful management of individual cases with brain and spinal cord stimulation, it has not been possible to develop a system of management that is consistently successful, mainly due to the paucity of basic neurophysiological data about PLP and its pathways in the central nervous system (CNS). Functional imaging offers a way of collecting information about the basic mechanisms and pathways of PLP from patients without the excessive risk of more invasive penetrating electrode studies or the questionable reliability of animal data. There have been very few studies that have looked at the direct effect of CNS stimulation on regional brain activation and correlation with the pain state. We describe two cases of PLP that have been satisfactorily treated with CNS stimulation (motor cortex and then periventricular gray in one and spinal cord in the other) and have been subjected to single photon emission computed tomography (SPECT) studies when in pain and then during stimulation with recorded pain relief. We found that regardless of the site of stimulation in the CNS, pain relief is associated with blood flow changes in similar areas of the brain, mainly the parietal and cingulate cortex and also in the thalamic nuclei and the central gray matter. Further studies of this kind should reveal more about the complex mechanisms of PLP and other forms of neuropathic pain.

  16. Phantom pain after eye amputation

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B

    2011-01-01

    Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation,...... appears to be similar to the phantom pain suffered by limb amputees. Patients should be informed about this potential complication before surgery.......Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation...... was conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19–88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2–46). Phantom...

  17. Imaginería motora graduada en el síndrome de miembro fantasma con dolor Graded motor imagery in the phantom limb syndrome with pain

    Directory of Open Access Journals (Sweden)

    M. A. Morales-Osorio

    2012-08-01

    Full Text Available Nuevas investigaciones sobre los cambios corticales en pacientes con dolor crónico han llevado a una reevaluación de las patologías que cursan con dolor crónico y sus tratamientos. Este es el caso del síndrome de miembro fantasma con dolor (SMFD, el cual se centraba en los estímulos nociceptivos periféricos, y ahora se replantean como una disfunción a nivel central. Una de las herramientas altamente evidencia y muchas veces desconocida para los terapeutas es la imaginería motora graduada (IMG. Esta técnica intenta normalizar la secuencia de procesamientos centrales para remediar el dolor crónico amparado en la neurociencias y en dos regalos de esta, como son las neuronas espejos y la neuromatriz. Este artículo resume brevemente los componentes básicos de la IMG, su aplicación y sus beneficios, la cual es la base de trabajo de nuestra línea de investigación, diseñado para los pacientes con SMFD, perteneciente a un centro clínico de la ciudad de Cartagena de Indias en Colombia.New investigations on cortical changes in patients with chronic pain have led to a reassessment of the pathologies that occur with chronic pain and its treatment. This is the case of Phantom limb syndrome with pain (PLP, which focused on peripheral nociceptive stimulus, and are now rethinking as a dysfunction at central level. One of the tools often highly evidence and therapists is unknown to the Graded motor imagery (IMG. This technique attempts to normalize the central processing sequence to remedy chronic pain, supported in the neurosciences and the two gifts, such as mirror neurons and the neuromatrix. This article briefly summarizes the basic components of IMG, your application and its benefits, which is the working basis of our research, designed for patients with SMFD belonging to a clinical center in Cartagena de Indias in Colombia.

  18. Mirror Therapy and Transcutaneous Electrical Nerve Stimulation for Management of Phantom Limb Pain in Amputees - A Single Blinded Randomized Controlled Trial.

    Science.gov (United States)

    Tilak, Merlyn; Isaac, Serin Anna; Fletcher, Jebaraj; Vasanthan, Lenny Thinagaran; Subbaiah, Rajalakshmi Sankaran; Babu, Andrew; Bhide, Rohit; Tharion, George

    2016-06-01

    Phantom limb pain (PLP) can be disabling for nearly two thirds of amputees. Hence, there is a need to find an effective and inexpensive treatment that can be self administered. Among the non-pharmacological treatment for PLP, transcutaneous electrical nerve stimulation (TENS) applied to the contralateral extremity and mirror therapy are two promising options. However, there are no studies to compare the two treatments. The purpose of this study is to evaluate and compare mirror therapy and TENS in the management of PLP in subjects with amputation. The study was an assessor blinded randomized controlled trial conducted at Physiotherapy Gymnasium of Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore. Twenty-six subjects with PLP consented to participate. An initial assessment of pain using visual analogue scale (VAS) and universal pain score (UPS) was performed by a therapist blinded to the treatment given. Random allocation into Group I-mirror therapy and Group II-TENS was carried out. After 4 days of treatment, pain was re-assessed by the same therapist. The mean difference in Pre and Post values were compared among the groups. The change in pre-post score was analyzed using the paired t test. Participants of Group I had significant decrease in pain [VAS ( p = 0.003) and UPS ( p = 0.001)]. Group II also showed a significant reduction in pain [VAS ( p = 0.003) and UPS ( p = 0.002)]. However, no difference was observed between the two groups [VAS ( p = 0.223 and UPS ( p = 0.956)]. Both Mirror Therapy and TENS were found to be effective in pain reduction on a short-term basis. However, no difference between the two groups was found. Substantiation with long-term follow-up is essential to find its long-term effectiveness. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  19. A gênese cerebral da imagem corporal: algumas considerações sobre o fenômeno dos membros fantasmas em Ramachandran The cerebral genesis of body image: some considerations about phantom-limbs in Ramachandran

    Directory of Open Access Journals (Sweden)

    Sergio Gomes da Silva

    2013-01-01

    Full Text Available Os distúrbios da imagem do corpo, na forma conferida pelo fenômeno dos "membros fantasmas", tomaram grande parte dos estudos do neurologista indiano V. S. Ramachandran. Seu trabalho, por meio de testes psicofísicos e estudos de imagem funcional em pacientes com "membros fantasmas", demonstrou aquilo que ele denominou "plasticidade neural" ou "plasticidade cortical" em cérebros humanos adultos. Este artigo tem por objetivo analisar criticamente a construção da imagem do corpo, da interioridade e do self a partir das principais teses neurológicas de Ramachandran sobre o fenômeno dos "membros fantasmas". Defende-se a ideia de que, apesar de o autor apresentar novas modalidades de descrições subjetivas e narrativas da mente, a experiência subjetiva e a construção da imagem corporal também devem ser explicadas em termos da relação corpo-ambiente ou corpo-mundo, na qual se destaca o papel da linguagem e das narrativas de si.The body image problems, as provided by "phantom limbs", took most studies of Indian neurologist V. S. Ramachandran. His work, through psychophysical tests and functional imaging studies in patients with "phantom limbs", demonstrated the "neural plasticity" or "cortical plasticity" in the adult human brain. This paper aims to examine the construction of body image, the inner life and the "self" from the Ramachandran neurological approaches on the phenomenon of "phantom limbs." We supports the idea that although the author presents new subjective and narrative descriptions of mind, the subjective experience and the construction of body image should also be explained in terms of the body-environment or body-world relationship, in which the role language and self-narratives stand out.

  20. Fibroadenoma in axillary supernumerary breast: case report

    Directory of Open Access Journals (Sweden)

    Délio Marques Conde

    Full Text Available CONTEXT: Supernumerary breast tissue may be affected by the same diseases and alterations that compromise topical breast tissue. Nevertheless, reports of fibroadenoma in supernumerary breast tissue in the axillae are rare. OBJECTIVE: To describe a case of fibroadenoma in an axillary supernumerary breast. DESIGN: Case report. CASE REPORT: A 39-year-old woman was referred to the gynecology and obstetrics outpatient clinic at Hospital Estadual Sumaré, complaining of bilateral axillary masses. The patient reported cosmetic problems and local pain and discomfort. On physical examination, alterations compatible with bilateral axillary accessory breasts, without palpable nodules, were observed. Supplementary examinations (mammography and ultrasonography revealed a 1.1 cm mass in the right axillary breast. The patient underwent resection of the supernumerary breasts and histopathological examination revealed fibroadenoma of the right axillary breast tissue.

  1. The management of premolar supernumeraries in three orthodontic cases.

    LENUS (Irish Health Repository)

    McNamara, C M

    1997-01-01

    This paper reviews the incidence, etiology and location of supernumerary teeth with emphasis on premolar supernumeraries and examines the management of supernumerary premolars of three patients undergoing orthodontics. These cases demonstrate that the management of premolars is assessed individually and treatments based on potential complications, which may occur during the orthodontic and surgical management of the dentition. Progress and posttreatment radiographs are recommended for the assessment of late forming supernumerary teeth.

  2. Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth

    OpenAIRE

    Ata-Ali Mahmud, Fadi; Ata-Ali Mahmud, Francisco Javier; Peñarrocha Oltra, David; Peñarrocha Diago, Miguel

    2014-01-01

    The aim of this article was to review the literature on supernumerary teeth, analyzing their prevalence, etiology, diagnosis, treatment and possible complications. An electronic search was made in the Pubmed-Medline database up to January 2014 using the key search terms “multiple supernumerary teeth” (n=279), “prevalence supernumerary teeth” (n=361), and “supernumerary teeth” (n=2412). In addition to the articles initially identified, others were included in the review proceeding from a manua...

  3. Supernumerary teeth: Report of four unusual cases

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2012-01-01

    Full Text Available Supernumerary tooth denotes duplication of tooth in the normal series. It is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. The supernumerary tooth might cause esthetic and/or functional problems, especially if it is situated in the maxillary anterior region. Complications reported were delayed or prevented eruption of succedaneous teeth, displacement or rotation, crowding of the affected region, abnormal diastema, dilacerations, cystic formation, and sometime eruption into the nasal cavity. In this case report, four unusual cases of supernumerary teeth that resulted in varying degrees of disturbances in permanent dentition are presented. Conservative surgical intervention and light orthodontic forces were used to bring the teeth into normal position with minimal disturbance to the surrounding oral structures.

  4. Supernumerary teeth: Report of four unusual cases.

    Science.gov (United States)

    Kumar, Arun; Namdev, Ritu; Bakshi, Lokesh; Dutta, Samir

    2012-04-01

    Supernumerary tooth denotes duplication of tooth in the normal series. It is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. The supernumerary tooth might cause esthetic and/or functional problems, especially if it is situated in the maxillary anterior region. Complications reported were delayed or prevented eruption of succedaneous teeth, displacement or rotation, crowding of the affected region, abnormal diastema, dilacerations, cystic formation, and sometime eruption into the nasal cavity. In this case report, four unusual cases of supernumerary teeth that resulted in varying degrees of disturbances in permanent dentition are presented. Conservative surgical intervention and light orthodontic forces were used to bring the teeth into normal position with minimal disturbance to the surrounding oral structures.

  5. Laparoscopic management of tumor in supernumerary ovary

    Science.gov (United States)

    Prakash, Ved; Kant, Anita; Parashar, Abha; Rani, Uma

    2016-01-01

    Laparoscopic management of most of the adnexal masses has become feasible in the present era of advancing endoscopic techniques. A postmenopausal lady presented with lump in the abdomen, appeared to be a solid ovarian mass on ultrasound, and magnetic resonance imaging. On laparoscopy, both the ovaries were normal and the mass was not connected to uterus or adnexa. The mass was removed and histopathology confirmed it to be ovarian tissue thus confirming it to be a tumor in a supernumerary ovary. Examples of supernumerary ovary are among the rarest of gynecological abnormalities. PMID:27134478

  6. Laparoscopic management of tumor in supernumerary ovary

    Directory of Open Access Journals (Sweden)

    Ved Prakash

    2016-01-01

    Full Text Available Laparoscopic management of most of the adnexal masses has become feasible in the present era of advancing endoscopic techniques. A postmenopausal lady presented with lump in the abdomen, appeared to be a solid ovarian mass on ultrasound, and magnetic resonance imaging. On laparoscopy, both the ovaries were normal and the mass was not connected to uterus or adnexa. The mass was removed and histopathology confirmed it to be ovarian tissue thus confirming it to be a tumor in a supernumerary ovary. Examples of supernumerary ovary are among the rarest of gynecological abnormalities.

  7. Supernumerary Teeth in Indian Children: A Survey of 300 Cases

    Directory of Open Access Journals (Sweden)

    Amita Sharma

    2012-01-01

    Full Text Available The aim of this investigation was to study children with supernumerary teeth who visited the Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Rohtak, Haryana, India. Only children with supernumerary teeth were included in the study while patients having supernumerary teeth with associated syndromes were excluded. Supernumeraries were detected by clinical and radiographic examination. The results indicated that males were affected more than females with a sex ratio of 2.9 : 1. Single supernumerary tooth was seen in 79% of the patients, 20% had double, and 1% had three or more supernumeraries. Premaxillary supernumeraries accounted for 93.8% of the cases. Conical shaped supernumerary teeth were the most common type (59.7%. Majority of supernumeraries remained unerupted (65%. Fusion of supernumerary tooth with a regular tooth was observed in 4% of the patients. Talon cusp, an associated dental anomaly, was seen in 5% of the cases. Simultaneous hypodontia occurred in 2.3% of patients with supernumeraries.

  8. Combination treatment of HIFU and rehabilitation on phantom limb pain after amputation%聚焦超声联合常规康复治疗对截肢后幻肢痛的疗效

    Institute of Scientific and Technical Information of China (English)

    唐映; 刘杰文; 许晓光

    2015-01-01

    目的:探讨聚焦超声联合常规康复对幻肢痛的治疗效果。方法将32例存在幻肢痛的患者分为治疗组和对照组,各16例,治疗组采用聚焦超声联合常规康复治疗,对照组单纯采用常规康复方法治疗。治疗30天后,以简明McGill疼痛问卷表评分作为评价指标,观察两组治疗效果。结果治疗组总有效率93.8%,对照组总有效率56.3%,两组比较差异有显著性意义(P<0.05);两组治疗前与治疗后SF-MPQ评分比较,差异均有显著性意义(P<0.05);治疗后组间SF-MPQ评分比较,差异有显著性意义(P<0.05)。结论聚焦超声和常规康复治疗联合运用对幻肢痛有很好的疗效。%Objective To study the effect of high intensity focus ultrasound ( HIFU) and rehabilitation treatment on phan-tom limb pain.Methods With randomized and controlled clinical research method, 32 cases of phantom limb pain were randomly divided into study group ( HIFU and rehabilitation therapy) and control group ( Rehabilitation therapy) with 16 patients in each group.After 30 days of treatment, a concise questionnaire SF-MPQ score was used as the evaluation in-dex of the therapeutic effect.Results The total effective rate of treatment group was 93.8%, compared to 56.3 % in the control group (P<0.05).The SF-MPQ score were significantly different before and after the treatment in both study group and control group (P<0.05).Comparison of SF-MPQ score between the two groups after treatment indicated sig-nificant difference (P<0.05).Conclusion HIFU and rehabilitation treatment have a good efficacy on limb pain.The combination of HIFU and rehabilitation treatment presents better results.

  9. From Phantom Limb Pain to study mechanism of Mental Content Representation%从幻肢痛现象看心理内容的表征问题

    Institute of Scientific and Technical Information of China (English)

    李侠

    2012-01-01

    幻肢痛现象自十九世纪后期被发现以来,它的作用机制目前并不十分清楚,也没有非常有效的治疗方法。但是这种现象对于认识论研究来说却提供了一个很好的视角。利用心理内容理论可以很好地解释幻肢痛现象,以及心理内容的表征机制,同时也能加深我们对人类认知之谜的了解。%Since the phenomena of Phatom limb pain had been discovered in the later ninteenth centries, its functional mechanism is not clear e- nough now and doesn't have a very effective therapeutic method. But this phenomena provides a good perspective for the research of epistemolo-gy. Using the theory of mental content can fully explain the phenomena of Pantom limb pain and the representation mechanism of mental con-tent , also it can enhance our understanding the riddle of cognition.

  10. Non-syndromic supernumerary teeth: report of a case with 6 supernumerary teeth

    Directory of Open Access Journals (Sweden)

    Taghibakhsh M

    2011-02-01

    Full Text Available "nBackground and Aims: Multiple supernumerary teeth are rare and often found in association with syndromes such as Gardner, Cleidocranial dysplasia and cleft lip and palate, with a much less chance for isolated"nnon-syndromic cases. The aim of this study was to report a case with 6 supernumerary teeth without syndromic association."nCase Report: The patient was a 33 year-old female, referred to oral diseases and diagnosis department with chief complaint of sensitivity to cold and hot food in right upper premolar region. Oral examination revealed 5 erupted lingually supernumerary teeth (four in mandibular and one in maxillary premolar region, respectively. Further panoramic radiography clarified an extra impacted tooth in the palatal region of left premolar maxillary area. All extra teeth had been appeared since the age of 17 during one year, as the patient claimed. Medical history and thorough clinical and paraclinical examinations were not significant except for the hypothyroidism, since 5 years ago. No other family member noticed to be the case. Based on our findings, a diagnosis of non-syndromic multiple supernumerary teeth was established."nConclusion: A thorough examination of each patient presented with supernumerary teeth, including panoramic and intraoral radiographic images may provide valuable information regarding accompanying syndromes and unerupted teeth. Early diagnosis is an essential step for orthodontic or surgical decisions making, preventing or avoiding worsening complications such as malocclusion, adjacent normal teeth delayed eruption or rotation, diasthema, cystic lesions and resorption of contiguous teeth.

  11. Human phantom

    CERN Multimedia

    CERN PhotoLab

    1973-01-01

    This human phantom has been received by CERN on loan from the State Committee of the USSR for the Utilization of Atomic Energy. It is used by the Health Physics Group to study personel radiation doses near the accelerators.

  12. Canaliculitis in supernumerary puncta and canaliculi

    Directory of Open Access Journals (Sweden)

    Ku Chui Yong

    2011-08-01

    Full Text Available We report the first case of supernumerary puncta and canaliculi presented with canaliculitis. A-59 year-old gentleman presented with painful swelling of the left lower lid for a week, which was associated with epiphora. The swelling was confined to the nasal aspect of the left lower lid (0.5¥0.5 mm with inflamed overlying skin. Two puncta (0.5 mm apart were noted. The outer punctum at the normal anatomical position was a cul-de-sac while the inner punctum it the caruncle was patent. We described the embryology leading to supernumerary puncta and canaliculi to explain the paradoxical patency of the abnormally located punctum as well as the pathomechanism leading to canaliculitis. The patient was treated with oral cloxacillin 500 mg, 6 hourly for 5 days; the cellulitis subsided after three days.

  13. 美金刚联合奥卡西平治疗术后幻肢痛%Memantine and Oxcarbazepine in the Treatment of Phantom Limb Pain after Surgery

    Institute of Scientific and Technical Information of China (English)

    黄立伟; 雷革胜; 郑联合; 胡晓辉

    2015-01-01

    Objective To observe the ef ect of Memantine and Oxcarbazepine for phantom limb pain after surgery. Methods 20 inpatient after high level of amputation were treated with various oral doses of Memantine and Oxcarbazepine. Pain-persist during ,pain severity and drug adverse reaction were observed in various time points. Results In half of 20 patients pain relieved completely after 1 week treatment, the other improved obviously in 2 weeks. 16 patients complained of no discomfort, 2 patients had mild dizziness , 2 patients had mild nausea. Al patients remained therapy and had normal routine blood test, liver function and renal function in the end of 14-day-admininstration. Conclusion Memantine and Oxcarbazepine treats phantom limb pain after surgery ef ectly and safely.%目的观察美金刚联合奥卡西平对术后幻肢痛的疗效。方法对骨科20例高位截肢后出现幻肢痛的住院患者口服美金刚联合奥卡西平治疗,观察不同时间疼痛持续时间、程度及药物不良反应。结果10例患者服药1w后临床症状明显缓解,10例患者2w时症状明显减轻。16例患者服药后未有不良反应主诉,2例服药初期有轻度头昏,2例轻度恶心,均未停药,对症处理后缓解。治疗14d末检查血常规、肝功能、肾功能未见异常。结论美金刚联合奥卡西平治疗术后幻肢痛安全有效。

  14. Supernumerary teeth: Review of literature and decision support system

    Directory of Open Access Journals (Sweden)

    Deepti Amarlal

    2013-01-01

    Full Text Available Supernumerary teeth are those which are additional or in excess of the normal number. They can be either single or multiple, unilateral or bilateral and can be present anywhere in the dental arch with predilection for the premaxilla. Supernumerary teeth are mostly classified on position and form. Timing of surgical intervention of supernumerary teeth has been controversial with various authors having different opinions. Hence a new decision support system is put forward which can help in the treatment planning of supernumerary teeth.

  15. The effects of impacted premaxillary supernumerary teeth on permanent incisors

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Yun Hoa; Kim, Ji Yeon; Cho, Bong Hae [School of Dentistry, Pusan National University, Yangsan (Korea, Republic of)

    2016-12-15

    The aim of this study was to examine the radiographic features associated with impacted premaxillary supernumerary teeth, to determine the relationship between their characteristics and their effects on permanent incisors, and to investigate the types of orthodontic treatment that patients received after the extraction of impacted supernumerary teeth. The clinical records and radiographs of 193 patients whose impacted premaxillary supernumerary teeth were removed were retrospectively reviewed, and 241 impacted supernumerary teeth were examined. Cone-beam computed tomographic images and panoramic radiographs were examined to determine the number, location, sagittal position, orientation, and morphology of the supernumerary teeth. Their effects on permanent incisors and the orthodontic treatment received by patients after the extraction of the supernumeraries were also investigated. Supernumerary teeth were most frequently observed in the central incisor region, in the palatal position, in the inverted orientation, and were most commonly conical in shape. The most common complication was median diastema, followed by displacement and delayed eruption of the adjacent incisors. Ten (71.4%) of the 14 odontomas showed delayed eruption of the adjacent incisors. Displacement of the incisors was more frequently observed in association with supernumerary teeth with tuberculate or supplemental shapes. Orthodontic traction was most frequently performed after the removal of odontomas. In 32 cases (13.3%), permanent incisors erupted after the orthodontic creation of sufficient space. Median diastema was most common complication. The delayed eruption of incisors was common in supernumerary teeth with a vertical orientation and an odontoma shape.

  16. The effects of impacted premaxillary supernumerary teeth on permanent incisors

    Science.gov (United States)

    Jung, Yun-Hoa; Kim, Ji-Yeon

    2016-01-01

    Purpose The aim of this study was to examine the radiographic features associated with impacted premaxillary supernumerary teeth, to determine the relationship between their characteristics and their effects on permanent incisors, and to investigate the types of orthodontic treatment that patients received after the extraction of impacted supernumerary teeth. Materials and Methods The clinical records and radiographs of 193 patients whose impacted premaxillary supernumerary teeth were removed were retrospectively reviewed, and 241 impacted supernumerary teeth were examined. Cone-beam computed tomographic images and panoramic radiographs were examined to determine the number, location, sagittal position, orientation, and morphology of the supernumerary teeth. Their effects on permanent incisors and the orthodontic treatment received by patients after the extraction of the supernumeraries were also investigated. Results Supernumerary teeth were most frequently observed in the central incisor region, in the palatal position, in the inverted orientation, and were most commonly conical in shape. The most common complication was median diastema, followed by displacement and delayed eruption of the adjacent incisors. Ten (71.4%) of the 14 odontomas showed delayed eruption of the adjacent incisors. Displacement of the incisors was more frequently observed in association with supernumerary teeth with tuberculate or supplemental shapes. Orthodontic traction was most frequently performed after the removal of odontomas. In 32 cases (13.3%), permanent incisors erupted after the orthodontic creation of sufficient space. Conclusion Median diastema was most common complication. The delayed eruption of incisors was common in supernumerary teeth with a vertical orientation and an odontoma shape. PMID:28035303

  17. Bilateral supernumerary teeth in deciduous dentition-a rarity.

    Science.gov (United States)

    Acharya, Sonu; Ghosh, Chiranjit; Mondal, Pradeep Kumar

    2014-05-01

    Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition and more often seen in males. A supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. Here we discuss a case of bilateral supernumerary teeth in deciduous dentition in a female child.

  18. Impacted supernumerary tooth in coronoid process: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won Se; Lee, Je Ho; Park, Hyok; Jung, Ho Gul; Kim, Kee Deog [Yonsei University College of Dentistry, Seoul (Korea, Republic of)

    2010-06-15

    Impaction of tooth is a situation in which an unerupted tooth is wedged against another tooth or teeth or otherwise located so that it cannot erupt normally. The supernumerary tooth is also called as hyperdontia and defined as the condition of having additional tooth to the regular number of teeth. The most common supernumerary tooth is a mesiodens, which is a mal-formed, peg-like tooth that occurs between the maxillary incisors. The supernumerary tooth is commonly impacted but they are frequently impacted on maxilla. Ectopic impaction of supernumerary tooth on mandibular condyle, coronoid process, ascending ramus, and pterygomandibular space is very rare condition. In this case, we report a case of impacted supernumerary tooth on mandibular sigmoid notch without definite pathologic change.

  19. Bilaterally impacted mandibular supernumerary premolars associated with unusual clinical complications

    Directory of Open Access Journals (Sweden)

    Zameer Pasha

    2013-01-01

    Full Text Available Supernumerary teeth are extra teeth in comparison to the normal dentition. Their prevalence varies between 0.1% and 3.8%. Supernumeraries are more common in permanent dentition and its incidence is higher in maxillary incisor region, followed by maxillary third molar and mandibular molar, premolar, canine, and lateral incisor. The prevalence of supernumerary premolars is between 0.075-0.26%, and they may occur in single or multiple numbers Bilateral occurrence is uncommon and large percentage of supernumerary premolars remains impacted, unerupted, and usually asymptomatic; radiograph plays an important role in diagnosis of these. The present paper reports a case of bilaterally impacted completely developed supernumerary premolars associated with common clinical complication in unusual manner along with taurodontism of the upper and lower molars.

  20. Multilobed mesiodens: a supernumerary tooth with unusual morphology.

    Science.gov (United States)

    Dave, Bhavna; Patel, Jalark; Swadas, Milan; Mallikarjuna, Rachappa

    2013-02-06

    An 8-year-old boy came with a chief complaint of an abnormally shaped tooth situated in upper front teeth region. On examination a supernumerary tooth with multiple lobes was present palatally to the maxillary right permanent central incisor. The morphology of the tooth crown was found to be unusual due to the presence of five lobes in the crown portion. Because of the supernumerary tooth, the permanent right central incisor was displaced labially. Radiographic examination showed a completely formed supernumerary tooth with dilacerated root. On the basis of clinical and radiographic examination, the supernumerary tooth was diagnosed as multilobed mesiodens. Since patient expressed dissatisfaction with the presence of supernumerary tooth, it was decided to extract this mesiodens followed by orthodontic treatment for alignment of labially placed maxillary right permanent central incisor.

  1. Supernumerary and supplemental teeth: case report.

    Science.gov (United States)

    Lo Giudice, G; Nigrone, V; Longo, A; Cicciù, M

    2008-06-01

    This is to report the case of a ten year old child affected by a numeric dental anomaly showing the pathologic condition characterised by the simultaneous presence of supernumerary and supplemental teeth. The anomaly was analysed to plan the best surgical and orthodontic treatments. Dental history, clinical and instrumental examinations were made to perform a correct orthodontic examination and diagnosis. A young patient was affected by numeric dental anomaly in the upper jaw. We observed a high number of teeth, specifically two normally formed supplemental lateral permanent incisors and an unerupted mesiodens placed between the upper central incisors. Firstly, the supplemental lateral teeth were extracted. This surgical therapy and the application of a space maintainer were made to permit the eruption of the permanent canines. Then the mesiodens also underwent surgical treatment (i.e. extraction). Eventually, physiologic eruption of permanent teeth was allowed by the planned surgical-orthodontic treatment. Aim of the surgical-orthodontic treatment was extraction of the unerupted supernumerary teeth to obtain the physiologic eruption of the permanent ones. Orthodontic treatment is important to solve malocclusions and maintaining the space for the eruption of permanent teeth. Aesthetics and function are two important parameters in modern dentistry. All clinicians should try to make a correct and rational diagnosis for both simple and complex dental pathologies. Particularly in young children, invasive and surgical disinclusive techniques can be substituted by interceptive orthodontic treatments.

  2. Graphene with vacancies: Supernumerary zero modes

    Science.gov (United States)

    Weik, Norman; Schindler, Johannes; Bera, Soumya; Solomon, Gemma C.; Evers, Ferdinand

    2016-08-01

    The density of states ϱ (E ) of graphene is investigated within the tight-binding (Hückel) approximation in the presence of vacancies. They introduce a nonvanishing density of zero modes nzm that act as midgap states, ϱ (E ) =nzmδ (E ) +smooth . As is well known, the actual number of zero modes per sample can, in principle, exceed the sublattice imbalance, Nzm≥|NA-NB| , where NA,NB denote the number of carbon atoms in each sublattice. In this paper, we establish a stronger relation that is valid in the thermodynamic limit and that involves the concentration of zero modes, nzm>|cA-cB| , where cA and cB denote the concentration of vacancies per sublattice; in particular, nzm is nonvanishing even in the case of balanced disorder, NA/NB=1 . Adopting terminology from benzoid graph theory, the excess modes associated with the current carrying backbone (percolation cluster) are called supernumerary. In the simplest cases, such modes can be associated with structural elements such as carbon atoms connected with a single bond, only. Our result suggests that the continuum limit of bipartite hopping models supports nontrivial "supernumerary" terms that escape the present continuum descriptions.

  3. Multi-variate regression analysis of development of phantom limb pain after amputation%截肢术后幻肢痛发生的多因素回归分析

    Institute of Scientific and Technical Information of China (English)

    朱天琦; 蒋宗滨; 赵劲民; 彭宇; 曾金; 李锋; 蒋奕红

    2011-01-01

    Objective To investigate the factors related with the development of phantom limb pain (PLP) in amputated patients. Methods 226 cases of patient received amputation surgery have been surveyed using the method of telephone follow-up according to a designing questionnaire. The factors that may influence the development of PLP have been analyzed with univariately and multi-variately regression analysis. Results The factors which included method of anesthesia, pain before the amputation, postoperative analgesia, complication and stump pain were related with the development of PLP by univarite analysis (P 0.05). The factors which included pain before the amputation (OR = 2.60), stump pain (OR = 3.70), general anesthesia (OR = 2.94) and postoperative analgesia (OR = 0.44) were independent factors in multi-variately analysis (P 0.05),多因素分析进一步证实影响幻肢痛发生的独立因素分别为术前疼痛(OR=2.60),残肢痛(OR=3.70),全身麻醉(OR=2.94)和术后镇痛(OR=0.44)(P<0.05).结论:术前疼痛、残肢痛、全身麻醉是幻肢痛发生的相关危险因素,术后镇痛是幻肢痛发生的保护因素,对于预防幻肢痛的发生具有重要的作用.

  4. Phantom pain after eye amputation.

    Science.gov (United States)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B

    2011-02-01

    To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation, orbital exenteration or secondary implantation of an orbital implant in the period between 1993 and 2003. A total of 267 patients were identified and invited to participate; of these, 173 agreed to participate. These patients' medical records were reviewed. A structured interview focusing on pain was conducted by a trained interviewer. Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19-88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2-46). Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n = 19); (ii) radiating, zapping or shooting (n = 8); (iii) superficial burning or stinging (n = 5); or a mixture of these different pain qualities (n = 7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 (range: 1-89). One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain.   Phantom pain after eye amputation is relatively common. The pain appears to be similar to the phantom pain suffered by limb amputees. Patients should be informed about this potential complication before surgery. © 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.

  5. Clinical management of supernumerary teeth: A report of two cases

    Directory of Open Access Journals (Sweden)

    Mittal M

    2010-09-01

    Full Text Available Supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e. molars, premolars or anterior teeth, or it may bear little resemblancein size or shape to which it is associated. Many complications can be associated with supernumeraries, like impaction, delayed eruption or ectopic eruption of adjacent teeth, crowding, development of median diastema and eruption into floor of the nasal cavity. This may also cause the formation of follicular cysts with significant bone destruction. Early intervention to remove it is usually required to obtain reasonable alignment and occlusal relationship. This article will present the clinical management of an (i impacted supernumerary tooth impeding the eruption of maxillary central incisor and (ii erupted supernumerary tooth with midline diastema.

  6. Multiple Geminated Supernumerary Premolars: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Atul Soin

    2015-01-01

    Full Text Available Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. Gemination is defined as an attempt by a single tooth bud to divide, with a resultant formation of either a large tooth with a bifid crown or two completely divided teeth throughout the crown and root. Geminated supernumerary premolar is a rarity and the possibility of multiple occurrences is even rarer. An exhaustive review of English literature and a PubMed search conducted using the terms “gemination’’ and “multiple geminated supernumerary” revealed no case of multiple geminated supernumerary premolars. We report a case of multiple geminated supernumerary premolars in a 23-year-old male.

  7. Multiple Geminated Supernumerary Premolars: A Rare Case Report

    Science.gov (United States)

    Soin, Atul; Sharma, Gaurav; Soin, Gayatri; Raina, Anudeep; Mutneja, Puneet; Nagpal, Archna

    2015-01-01

    Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. Gemination is defined as an attempt by a single tooth bud to divide, with a resultant formation of either a large tooth with a bifid crown or two completely divided teeth throughout the crown and root. Geminated supernumerary premolar is a rarity and the possibility of multiple occurrences is even rarer. An exhaustive review of English literature and a PubMed search conducted using the terms “gemination” and “multiple geminated supernumerary” revealed no case of multiple geminated supernumerary premolars. We report a case of multiple geminated supernumerary premolars in a 23-year-old male. PMID:26078889

  8. Phantom limb pain%幻肢痛

    Institute of Scientific and Technical Information of China (English)

    张秀果

    2007-01-01

    幻肢现象不仅局限于四肢,身体其他部位被切除时也会发生,其中幻肢痛的发生率约占60%~70%.最近,其发病机制中大脑皮层功能重组和幻肢感、幻肢痛的相关性受到重视,认为很可能是幻肢痛产生的中枢性机制之一.幻肢痛的治疗极为困难,治疗方式多种多样,被证明行之有效的包括药物治疗、神经阻滞治疗、外科治疗、心理疗法等.治疗方案仍然没有统一和定论.

  9. Rare occurrence of bilaterally impacted mandibular supernumerary teeth

    Directory of Open Access Journals (Sweden)

    Vinay Kumar Bhardwaj

    2012-01-01

    Full Text Available Introduction: Supernumerary teeth are present in addition to the normal complement of teeth in permanent or deciduous dentitions. Incidence is high in permanent dentition, affects both the gender. They are more common in males, with the male to female ratio of 2:1. When the supernumerary teeth are causing problems such as, extensive resorption of adjacent teeth, hindering the eruption or malposition of permanent teeth, early surgical intervention is recommended. Case Report: A case of bilaterally impacted supernumerary premolars was reported when an orthopentomograph view was taken which revealed the presence of additional teeth impacted in relation to 35-36 and 45-46. Surgical removal was done as they were resorbing the roots of teeth in their vicinity. Discussion: Literature reports increased occurrence of the supernumeraries in the maxilla but supernumerary premolars are more likely to develop in the mandible. Etiology of supernumerary teeth is ambiguous and is due to following conditions:atavism or reversion, heredity, aberrations during embryologic formation, progress zone, and unified etiologic explanation.

  10. 阿米替林对脊髓电刺激治疗幻肢痛疗效的影响%Influence of Amitriptyline to the Effectiveness of the Spinal Cord Stimulation to the Phantom Limb Pain

    Institute of Scientific and Technical Information of China (English)

    常崇旺; 耿宁; 李楠; 王景; 马久红; 王学廉

    2011-01-01

    目的:本研究旨在探讨阿米替林干预对脊髓电刺激(SCS)治疗幻肢痛疗效的影响.方法:研究对象为2007年1月至2009年6月在我科行SCS置入术且符合入组标准并自愿参加研究的幻肢痛患者,共获7例.术后SCS均开启,阿米替林治疗在术后1个月时开始.疼痛、情绪、生活质量评估采用视觉模拟评分法(visual analogue scales,VAS法),现时疼痛强度评分法(present pain intensity,PPD,综合性医院焦虑抑郁量表(The Hospital Anxiety and Depression Scale,HAD),疼痛失能指数(Pain disability index,PDI).结果:(1)开启SCS后患者的疼痛、抑郁焦虑情绪及生活质量均得到显著改善.(2)所有患者在使用阿米替林治疗以后疼痛、情绪及生活质量也显著改善.结论:阿米替林能显著提高SCS对幻肢痛的疗效.%Objective: We aimed to study how the amitriptyline intervention would have impact the curative effects of the phantom limb pain (PLP) patients who had been treated with the spinal cord stimulation (SCS). Methods: All the PLP patients who accepted the SCS implantation at our therapy centre during January 2007 to June 2009 and who fit in the selected standard and were the volunteers to this research were selected as subjects and we obtained 7 patients finally. All the patients' SCS were opened post-operation immediately and all the patients were taken amitriptyline one month post-operation. We used visual analogue scales (VAS), present pain intensity (PPI), the hospital anxiety and depression scale(HAD) and pain disability index(PDI) to assess the severity of pain, mood and the quality of life of the patients. Results: The pain, depression and anxiety mood and quality of life of these patients were improved dramatically after opened SCS post-operation. We obtained the same consequence after taken amitriptyline post-operation. Conclusion: Amitriptyline can promote the effectiveness of SCS of the PLP patients.

  11. Phantom limb pain in amputees: epidemiological investigation of 108 cases in Wenchuan Earthquake%5·12汶川地震绵竹灾区幻肢痛发生情况调查

    Institute of Scientific and Technical Information of China (English)

    杜海龙; 何纯青; 赵正恩; 许猛; 张立海; 柳现飞; 唐佩福

    2011-01-01

    目的 观察汶川地震伤员截肢后幻肢痛的流行病学特征,分析创伤性截肢术后幻肢痛发生的相关危险因素.方法 2008年8月~2010年5月期间,对四川省绵竹市5·12地震截肢伤员进行针对幻肢痛发生情况的现况调查,此后每3月一次电话随访直至术后2年.结果 本文调查了绵竹市147例截肢伤员,获得连续完整资料108例,幻肢痛的2年患病率是86例(79.6%),22例(20.4%)在截肢后2年内从未发生过幻肢痛.取截肢术后8个时间点(每3个月一次,共2年),计算幻肢痛发病率依次为:61.1%、62.9%、68.5%、70.4%、69.4%、66.7%、62.0%、62.0%.女性幻肢痛发病率(88.7%),明显高于男性(67.4%,P<0.05).结论 幻肢痛在四川地震截肢伤员当中有较高的发病率,女性比男性更容易发生幻肢痛.%Objective To investigate the epidemiological characteristics of phantom limb pain (PLP) in amputees due to earthquake trauma and risk factors thereof. Methods All amputees aged 8~80 found in Mianzhu City, Sichuan Province, 512 cases in total who were hurt during the Wenchuan Earthquake, 42 males and 64 females, underwent in-home survey on PLP and then telephone or outpatient department follow-up once 3 months was conducted for 2 years. Results Continuous and complete data were obtained from 108 cases with an effective rate of 73.5%. Eight-six of the 108 amputees ever suffered from PLP with a prevalence rate of 79.6%. And the prevalence rates of PLP at the 8 different time points during the 2 years of follow-up were 61.1%, 62.9%, 68.5%, 70.4%, 69.4%, 66.7%,62.0%, and 62.0% respectively. Fifty-five out of the 62 females (88.7%) suffered from PLP, with a prevalence rate of 88.7%, significantly higher than that among the males (67.4%, 31/46, P=0.037).Seventy-nine of the 86 PLP patients (91.9%)visited hospitals, 35 cases (40.7%) with PLP as the main complaint. There was not significant difference in the PLP prevalence rate between

  12. Small Supernumerary Marker Chromosomes in Human Infertility.

    Science.gov (United States)

    Armanet, Narjes; Tosca, Lucie; Brisset, Sophie; Liehr, Thomas; Tachdjian, Gérard

    2015-01-01

    Small supernumerary marker chromosomes (sSMC) are structurally abnormal chromosomes that cannot be unambiguously identified by banding cytogenetics. The objective of this study was to provide an overview of sSMC frequency and characterization in a context of infertility and to review the literature describing sSMC in relation with male and female infertility. Therefore, a systematic literature review on sSMC associated with infertility was conducted by means of a PubMed literature and a sSMC database (http://ssmc-tl.com/sSMC.html) search. A total of 234 patients with infertility were identified as carriers of sSMC. All chromosomes, except chromosomes 10, 19 and the X, were involved in sSMC, and in 72% the sSMC originated from acrocentric chromosomes. Euchromatic imbalances were caused by the presence of sSMC in 30% of the cases. Putative genes have been identified in only 1.2% of sSMC associated with infertility. The implication of sSMC in infertility could be due to a partial trisomy of some genes but also to mechanical effects perturbing meiosis. Further precise molecular and interphase-architecture studies on sSMC are needed in the future to characterize the relationship between this chromosomal anomaly and human infertility.

  13. Phantom testis syndrome: prevalence, phenomenology and putative mechanisms.

    Science.gov (United States)

    Pühse, Gerald; Wachsmuth, Julia Urte; Kemper, Sebastian; Husstedt, Ingo W; Kliesch, Sabine; Evers, Stefan

    2010-02-01

    Chronic phantom pain has been found in up to 78% of limb amputees and is a major complication of limb amputation. Less is known about phantom phenomena after the amputation of other, i.e. visceral, parts of the body. In a retrospective design, we identified 539 patients in whom one testis was removed between 1995 and 2005. The operative technique was a unilateral standard radical inguinal orchiectomy. The underlying pathology in all cases was a testicular germ cell tumour. All patients received a detailed questionnaire asking about the occurrence of phantom testis pain (pain felt in the removed testis), phantom testis sensations (non-painful sensations as if the removed testis was still intact) and hallucinations (illusionary perceptions on the removed testis). Furthermore, we asked about the occurrence and clinical presentation of pain before and after surgery and about pre-operative testicular pain. Out of 238 respondents, 125 patients (53%) reported any kind of phantom experience. The prevalence of phantom testis pain was 25% (60/238), non-painful phantom sensations 16% (37/238) and male gonad hallucinations 12% (28/238). Patients with phantom symptoms reported pre-operative pain in the removed testis more often than patients without phantom symptoms. This study presents first data on the clinical characteristics and possible mechanisms of the phantom testis syndrome after surgical removal of one testis.

  14. Non-syndrome associated multiple supernumerary teeth: A report of two cases

    Directory of Open Access Journals (Sweden)

    Nayak Ullal

    2006-05-01

    Full Text Available Multiple supernumerary teeth are usually associated with syndromes. On the contrary, multiple supernumerary teeth without association with any syndromes are very rare. This article presents a report of two cases with multiple supernumerary teeth not associated with any syndrome and emphasizes the routine advice of orthopantomogram whenever a single supernumerary tooth is detected irrespective of whether the patient has any syndrome or not.

  15. 脊髓后根入髓区切开术治疗创伤后幻肢痛的长期疗效分析%LONG-TERM EFFECTS OF DORSAL ROOT ENTRY ZONE LESIONS ON POST-TRAUMATIC PHANTOM LIMB PAIN

    Institute of Scientific and Technical Information of China (English)

    郑喆; 胡永生; 胡志伟; 陶蔚; 张晓华; 李勇杰

    2011-01-01

    Objective: To evaluate the long-term therapeutic effects of dorsal root entry zone (DREZ) lesions on post-traumatic phantom limb pain. Methods: 16 patients who underwent DREZ lesions for posttraumatic phantom limb pain were studied. Root avulsion was found in 14 patients. Oral pain relief (0% ~ 100% ) and surgical complications were followed up. Satisfactory result was defined as 50% to 100% oral pain relief. Results: The average follow-up period was 24.0 ± 15.0 months (ranged 6 months to 4 years) , and 11 patients got satisfactory pain relief. There was only one patient with severe surgical complication (severe sensory disturbance in the ipsilateral lower limb). Conclusion: Good long-term results could be obtained in patients with post-traumatic phantom limb pain after DREZ lesions.%目的:评价脊髓后根入髓区(dorsal root entry zone,DREZ)切开术治疗创伤后幻肢痛的长期疗效.方法:16例于2005年至2008年于我院功能神经外科行DREZ切开术的创伤后幻肢痛患者,其中14例有神经根撕脱,2例神经根萎缩.记录患者手术后的口述疼痛缓解率(0%~100%)和并发症,疼痛缓解≥50%认为手术疗效良好.结果:随访6个月至4年,平均24.0±15.0个月,11例(68.8%)患者手术疗效良好.术后出现同侧下肢严重深感觉障碍1例,无其它严重并发症.结论:DREZ切开术治疗创伤后幻肢痛的长期疗效良好.

  16. Whole-exome sequencing analysis of supernumerary teeth occurrence in Japanese individuals.

    Science.gov (United States)

    Takahashi, Masahiro; Hosomichi, Kazuyoshi; Yamaguchi, Tetsutaro; Yano, Keisuke; Funatsu, Takahiro; Adel, Mohamed; Haga, Shugo; Maki, Koutaro; Tajima, Atsushi

    2017-01-01

    A common disorder of human dentition is the existence of supernumerary teeth. Impacted supernumerary teeth occur most frequently in the maxillary incisor area and are termed mesiodens. We conducted whole-exome sequencing of non-syndromic Japanese individuals possessing supernumerary teeth to identify genes and/or loci involved in the pathogenesis of the condition.

  17. Late-Developing Supernumerary Premolars: Analysis of Different Therapeutic Approaches

    Directory of Open Access Journals (Sweden)

    Sergio Paduano

    2016-01-01

    Full Text Available This case series describes the different potential approaches to late-developing supernumerary premolars (LDSP. LDSP are supernumerary teeth (ST formed after the eruption of the permanent dentition; usually they develop in the premolar region of the upper and lower jaw. The choice to extract or to monitor the LDSP depends on many factors and has to be carefully planned due to the several risks that either the monitoring or the extraction could provoke. These four cases of LDSP showed different treatment plan alternatives derived from a scrupulous assessment of the clinical and radiographic information.

  18. Unique case of a geminated supernumerary tooth with trifid crown

    Energy Technology Data Exchange (ETDEWEB)

    Ather, Amber; Ather, Hunaiza; Sheth, Sanket Milan; Muliya, Vidya Saraswathi [Manipal College of Dental Sciences, Manipal (Korea, Republic of)

    2012-09-15

    Gemination, a relatively uncommon dental anomaly, is characterized by its peculiar representation as a tooth with a bifid crown and a common root and root canal. It usually occurs in primary dentition. To come across gemination in a supernumerary tooth is a rare phenomenon. The purpose of this paper is to present a unique case of hyperdontia wherein gemination in an impacted supernumerary tooth resulted in a trifid crown unlike the usual bifid crown. The role of conventional radiographs as well as computed tomography, to accurately determine the morphology and spatial location, and to arrive at a diagnosis, is also emphasized in this paper.

  19. FGF8 and SHH substitute for anterior-posterior tissue interactions to induce limb regeneration.

    Science.gov (United States)

    Nacu, Eugeniu; Gromberg, Elena; Oliveira, Catarina R; Drechsel, David; Tanaka, Elly M

    2016-05-19

    In salamanders, grafting of a left limb blastema onto a right limb stump yields regeneration of three limbs, the normal limb and two 'supernumerary' limbs. This experiment and other research have shown that the juxtaposition of anterior and posterior limb tissue plus innervation are necessary and sufficient to induce complete limb regeneration in salamanders. However, the cellular and molecular basis of the requirement for anterior-posterior tissue interactions were unknown. Here we have clarified the molecular basis of the requirement for both anterior and posterior tissue during limb regeneration and supernumerary limb formation in axolotls (Ambystoma mexicanum). We show that the two tissues provide complementary cross-inductive signals that are required for limb outgrowth. A blastema composed solely of anterior tissue normally regresses rather than forming a limb, but activation of hedgehog (HH) signalling was sufficient to drive regeneration of an anterior blastema to completion owing to its ability to maintain fibroblast growth factor (FGF) expression, the key signalling activity responsible for blastema outgrowth. In blastemas composed solely of posterior tissue, HH signalling was not sufficient to drive regeneration; however, ectopic expression of FGF8 together with endogenous HH signalling was sufficient. In axolotls, FGF8 is expressed only in the anterior mesenchyme and maintenance of its expression depends on sonic hedgehog (SHH) signalling from posterior tissue. Together, our findings identify key anteriorly and posteriorly localized signals that promote limb regeneration and show that these single factors are sufficient to drive non-regenerating blastemas to complete regeneration with full elaboration of skeletal elements.

  20. Imaginative resonance training (IRT) achieves elimination of amputees' phantom pain (PLP) coupled with a spontaneous in-depth proprioception of a restored limb as a marker for permanence and supported by pre-post functional magnetic resonance imaging (fMRI).

    Science.gov (United States)

    Meyer, Paul; Matthes, Christoph; Kusche, Karl Erwin; Maurer, Konrad

    2012-05-31

    Non-pharmacological approaches such as mirror therapy and graded motor imagery often provide amelioration of amputees' phantom limb pain (PLP), but elimination has proved difficult to achieve. Proprioception of the amputated limb has been noted in studies to be defective and/or distorted in the presence of PLP, but has not, apparently, been researched for various stages of amelioration up to the absence of PLP. Previous studies using functional magnetic resonance imaging (fMRI) suggested that pathological cortical reorganisation after amputation may be the underlying neurobiological correlate of PLP. We report two cases of permanent elimination of PLP after application of imaginative resonance training. The patients, 69 years and 84 years old, reported freedom from PLP together with in-depth achievement of proprioception of a restored limb at the end of the treatment, which may thus be taken as an indication of permanence. Pre/post fMRI for the first case showed, against a group of healthy controls, analogous changes of activation in the sensorimotor cortex.

  1. Supernumerary Teeth in Primary Dentition and Early Intervention: A Series of Case Reports

    Science.gov (United States)

    Bahadure, Rakesh N.; Thosar, Nilima; Jain, Eesha S.; Kharabe, Vidhi; Gaikwad, Rahul

    2012-01-01

    Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in lower arch. Early recognition and diagnosis of supernumerary teeth is important to prevent further complications in permanent dentition. Four cases of supernumerary teeth with mesiodens in upper and lower arch in primary dentition and their management have been discussed. PMID:22888456

  2. Supernumerary Teeth in Primary Dentition and Early Intervention: A Series of Case Reports

    Directory of Open Access Journals (Sweden)

    Rakesh N. Bahadure

    2012-01-01

    Full Text Available Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in lower arch. Early recognition and diagnosis of supernumerary teeth is important to prevent further complications in permanent dentition. Four cases of supernumerary teeth with mesiodens in upper and lower arch in primary dentition and their management have been discussed.

  3. Supernumerary teeth in primary dentition and early intervention: a series of case reports.

    Science.gov (United States)

    Bahadure, Rakesh N; Thosar, Nilima; Jain, Eesha S; Kharabe, Vidhi; Gaikwad, Rahul

    2012-01-01

    Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in lower arch. Early recognition and diagnosis of supernumerary teeth is important to prevent further complications in permanent dentition. Four cases of supernumerary teeth with mesiodens in upper and lower arch in primary dentition and their management have been discussed.

  4. Influence of Targeted Muscle Reinnervation on Phantom Limb Pain and Distribution of Reinnervated Nerve in Rats%目标肌肉神经分布重建对大鼠幻肢痛的影响及神经分布研究

    Institute of Scientific and Technical Information of China (English)

    吴凤霞; 杨琳; 张良清; 周慧; 李光林

    2013-01-01

      目标肌肉神经分布重建技术(Targeted Muscle Reinnervation,TMR)通过对假肢的实时直觉控制提高截肢者的运动功能。然而对于 TMR 技术是否能减轻幻肢痛、移植神经在肌肉内如何分布等问题,目前知之甚少。本文旨在探讨 TMR手术对大鼠幻肢痛的影响和术后目标肌肉内神经的再分布情况。我们利用坐骨神经横断组(SNT)作为大鼠的疼痛模型,将神经近端移植到目标肌肉中作为 TMR 模型,并通过大鼠行为学来评价疼痛程度。实验发现,对照组大鼠不出现自残行为,而 SNT 组和 TMR 组从手术后第二天开始出现自残行为并逐渐加重,但 TMR 组的自残情况明显轻于 SNT 组。利用Sihler’s 肌内神经染色法可以在目标肌肉内观察到移植神经末端再生的细小分支。实验结果初步证明 TMR 技术对幻肢痛有一定的缓解作用,并且术后的神经可以在目标肌肉内重新分支分布。%Targeted muscle reinnervation (TMR) can improve amputees’ movement ability by providing simultaneous and intuitive control of artificial limbs. However, little is known about whether TMR can relieve the phantom limb pain and how intramuscular nerve branches are distributed in the targeted muscle after the operation. The purpose of this study is to investigate the effects of TMR on phantom limb pain and to explore the possibility of post-operative neuranagenesis in rats. The rat model was established by sciatic nerves transaction (SNT group) and the proximal ends of these nerves were grafted into targeted muscles (TMR group). The degree of the phantom limb pain was measured by observing the autotomy behaviors of rats. The pilot results show that rats in the sham group have no autotomy behaviors, while rats in SNT group and TMR group show typical autotomy behaviors two days after the operations and the behaviors become worse gradually. However, the TMR group show obviously less pain than the

  5. Short-term clinical curative effects of fumigation therapy in treatment of phantom limb pain after traumatic amputation%熏蒸疗法治疗创伤性截肢后幻肢痛短期临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    牟燕媚; 池泓滟

    2015-01-01

    目的:观察海桐皮汤熏蒸疗法对创伤性截肢后幻肢痛的短期临床疗效。方法:将伴有幻肢痛的创伤性截肢患者90例分为2组,对照组45例采用常规的心理支持疗法和运动疗法,干预组45例在此基础上行海桐皮汤熏蒸疗法,3周后对2组疗效进行评价。结果:干预组总有效率95.56%(43/45),显著高于对照组的57.78%(26/45),差异有统计学意义(P<0.05)。同时,干预组患者的疼痛评定指数(PRI)及视觉模拟疼痛评分(VAS)均比对照组有明显改善( P<0.05)。结论:海桐皮汤熏蒸疗法对创伤性截肢后幻肢痛的短期临床疗效满意。%Objective ] To evaluate the short-term clinical curative effectsof fumigation therapy in treatment of phantom limb pain after traumatic amputation . [Method ] 90 patients with phantom limb pain after traumatic amputationwere divided into 2 groups .The control group that includes 45 patients was taken psychological support therapy and exercise therapy ,and the inter-vention group includingthe restpatients was given fumigation by usingpittosporum skin soupcombined with the conventional treat-ment .The clinical curative effects was evaluated after successive 3-week treatments .[Result]After 3 weeks ,the total effec-tive rate of the intervention group reached 95 .56% (43/45) ,which is significantly higher than the 57 .78% (26/45) of the control group (P< 0 .05) .In addition ,both the patient’s pain assessment index (PRI) and visual analog pain score (VAS) in intervention group were significantly difference than that in the control group (P<0 .05) .[Conclusion] The fumigation therapy of pittosporum skin soup can obtain satisfactory effects in treating phantom limb pain after traumatic amputation .

  6. Chromosomal breakpoints characterization of two supernumerary ring chromosomes 20.

    Science.gov (United States)

    Guediche, N; Brisset, S; Benichou, J-J; Guérin, N; Mabboux, P; Maurin, M-L; Bas, C; Laroudie, M; Picone, O; Goldszmidt, D; Prévot, S; Labrune, P; Tachdjian, G

    2010-02-01

    The occurrence of an additional ring chromosome 20 is a rare chromosome abnormality, and no common phenotype has been yet described. We report on two new patients presenting with a supernumerary ring chromosome 20 both prenatally diagnosed. The first presented with intrauterine growth retardation and some craniofacial dysmorphism, and the second case had a normal phenotype except for obesity. Conventional cytogenetic studies showed for each patient a small supernumerary marker chromosome (SMC). Using fluorescence in situ hybridization, these SMCs corresponded to ring chromosomes 20 including a part of short and long arms of chromosome 20. Detailed molecular cytogenetic characterization showed different breakpoints (20p11.23 and 20q11.23 for Patient 1 and 20p11.21 and 20q11.21 for Patient 2) and sizes of the two ring chromosomes 20 (13.6 Mb for case 1 and 4.8 Mb for case 2). Review of the 13 case reports of an extra r(20) ascertained postnatally (8 cases) and prenatally (5 cases) showed varying degrees of phenotypic abnormalities. We document a detailed molecular cytogenetic chromosomal breakpoints characterization of two cases of supernumerary ring chromosomes 20. These results emphasize the need to characterize precisely chromosomal breakpoints of supernumerary ring chromosomes 20 in order to establish genotype-phenotype correlation. This report may be helpful for prediction of natural history and outcome, particularly in prenatal diagnosis.

  7. Supernumerary ring chromosome 17 identified by fluorescent in situ hybridization

    Energy Technology Data Exchange (ETDEWEB)

    Fagan, K. [Hunter Area Pathology Service, New South Wales (Australia); Edwards, M. [Western Suburbs Hospital, New South Wales (Australia)

    1997-04-14

    We present a patient with multiple anomalies and severe developmental delay. A small supernumerary ring chromosome was found in 40% of her lymphocyte cells at birth. The origin of the marker chromosome could not be determined by GTG banding, but fluorescent in situ hybridization (FISH) later identified the marker as deriving from chromosome 17. 20 refs., 2 figs., 1 tab.

  8. Pediatric phantom vision (Charles Bonnet) syndrome.

    OpenAIRE

    Mewasingh, Leena D.; Kornreich, Charles; Christiaens, Florence; Christophe, Catherine; Dan, Bernard

    2002-01-01

    Visual symptomatology in childhood often presents diagnostic difficulties. Recurrent paroxysmal visual complaints, although typically associated with migraine, may also signal other disorders. We describe a 9-year-old partially sighted male with paroxysmal zoopsias resulting from Charles Bonnet syndrome. This condition is characterized by paroxysmal visual hallucinations occurring in patients with chronic visual impairment, akin to the phantom-limb phenomenon. This pediatric case is the fourt...

  9. Pediatric phantom vision (Charles Bonnet) syndrome.

    Science.gov (United States)

    Mewasingh, Leena D; Kornreich, Charles; Christiaens, Florence; Christophe, Catherine; Dan, Bernard

    2002-02-01

    Visual symptomatology in childhood often presents diagnostic difficulties. Recurrent paroxysmal visual complaints, although typically associated with migraine, may also signal other disorders. We describe a 9-year-old partially sighted male with paroxysmal zoopsias resulting from Charles Bonnet syndrome. This condition is characterized by paroxysmal visual hallucinations occurring in patients with chronic visual impairment, akin to the phantom-limb phenomenon. This pediatric case is the fourth report of this condition. We have reviewed the other cases.

  10. [The treatment of the phantom pain syndrome with tizanidine].

    Science.gov (United States)

    Vorobeĭchik, Ia M; Kukushkin, M L; Reshetniak, V K; Ovechkin, A M; Gnezdilov, A V

    1997-01-01

    The authors carried out estimation of analgetic effect of tisanidin by double blind test in patients with phantom limb pain syndrome. 14 patients took the medicine in a dose of 12 mg/day and 5 patients took placebo at the same dose. Characteristics and intensity of pain were estimated in accordance with McGill pain questionnaire and visual analogue scale. Pain possessed more than one sensory characteristics in the majority of patients. Tisanidin had a significant analgetic influence on all type of phantom limb pain: "neuralgic"--acute, shooting, transitory, "causalgic"--hot, burning, searing, "cramping" pain. Pain sensation did not decrease only in one of 14 patients treated with tisanidin. The authors explain the effectivity of the drug for treatment of phantom limb pain of different sensory modality by variety of the mechanisms of its therapeutic action, the capacity to decrease the releasing of excitatory neurotransmitter amino acids and the influence on alpha 2-adrenoceptors.

  11. BILATERAL MOLARIFORM SUPERNUMERARY TEETH IN THE ANTERIOR MAXILLA: A REPORT OF TWO CASES

    Directory of Open Access Journals (Sweden)

    Mehmet Cem ÖZDEN

    2017-01-01

    Full Text Available Supernumerary teeth are additional teeth besides the normal series and can be found in any region of the dental arch. Supernumerary teeth can be classified according to their form and locations. Early diagnosis and treatment of patients with supernumerary teeth may prevent or minimize complications. The treatment options depend on the type and position of the supernumerary tooth and its effect on the adjacent structures. Two male patients were referred to our clinic due to swelling in their maxillae and interrupted eruption of teeth. Upon radiological examination of the patients, impacted supernumerary teeth were found. Surgical removal of these teeth were perfomed and they were found to be molariform. We aim to present the two rare cases of molariform supernumerary teeth in this article.

  12. Bloqueo ciático continuo con catéter estimulador guiado mediante ecografía para tratamiento del miembro fantasma doloroso Ultrasound-guided continuous sciatic nerve block with stimulating catheter for the treatment of phantom limb pain

    Directory of Open Access Journals (Sweden)

    A. Martínez Navas

    2009-02-01

    Full Text Available Los bloqueos nerviosos periféricos pueden ser una alternativa a la analgesia intravenosa y epidural en el tratamiento del miembro fantasma doloroso. La dificultad en la localización del nervio ciático mediante neuroestimulación en pacientes con arteriopatía periférica y neuropatía puede verse aumentada por el hecho de presentar una amputación del miembro inferior, que imposibilita la observación de una respuesta motora en el pie coincidiendo con la localización del nervio. En estos casos, la ecografía puede convertirse en una técnica de localización nerviosa determinante del éxito de la analgesia ya que permite la identificación del nervio, así como la visualización en tiempo real de la posición relativa de la aguja y catéter respecto al nervio y la difusión del anestésico local administrado. Se presenta el caso de un paciente con miembro fantasma doloroso resistente al tratamiento convencional que se controló con un bloqueo ciático continuo con catéter estimulador guiado con ecografía.Peripheral nerve blocks can be an alternative to intravenous and epidural analgesia in the treatment of phantom limb pain. The difficulty of localizing the sciatic nerve through neurostimulation in patients with peripheral arteriopathy and neuropathy can be increased by lower limb amputation, making it impossible to observe a motor response in the foot coinciding with localization of the nerve. In these cases, ultrasonography can become a technique for nerve localization and determine the success of analgesic strategy, since it allows nerve identification, as well as visualization in real time of the relative position of the needle and catheter with respect to the nerve and the diffusion of the local anesthetic administered. We report the case of a patient with phantom limb pain refractory to conventional treatment, in whom pain control was achieved by ultrasound-guided continuous sciatic block with stimulating catheter.

  13. Múltiples dientes supernumerarios distomolares Multiple distomolars supernumerary teeth

    Directory of Open Access Journals (Sweden)

    F.J. Rodríguez Romero

    2009-12-01

    Full Text Available En una dentición normal, los dientes supernumerarios son aquellos descritos como adicionales a la serie. La etiología no esta clara. Se han descritos tanto en dentición primaria como en permanente, aunque son mas frecuentes en la dentición permanente. El objetivo de este informe es presentar un caso de una paciente con múltiples dientes supernumerarios distomolares. Cuartos molares bilaterales simétricos son sumamente raros.Supernumerary teeth are described as the teeth formed in excess of the number found in a normal dentition. The aetiology is not clear. Have been reported in both the primary and permanent dentition, although they are more prevalent in the permanent dentition. The purpose of this case report is to present a case of female patient with multiple distomolars supernumerary teeth. Bilateral symmetrical impacted fourth molars exceedingly uncommon.

  14. 幻肢痛大鼠脊髓背角神经元和突触数量的变化%Changes in the number of synapses and neurons in spinal dorsal horn in a rat model of phantom limb pain

    Institute of Scientific and Technical Information of China (English)

    林菁艳; 彭彬; 杨正伟; 闵苏

    2010-01-01

    Objective To investigate the changes in the number of synapses and neurons in the spinal dorsal horn in a rat model of phantom limb pain. Methods Eleven healthy adult SD rats of both sexes weighing 209-300 g were randomly divided into 2 groups: sham operation group (group S, n = 5) and phantom limb pain group (group P, n = 6). Phantom limb pain was induced by resection of a 0.5 cm segment of unilateral sciatic nerve in group P. In group S unilateral sciatic nerve was exposed but not transected. The animals were observed for autotomy and scored (0 = no autotomy, 13 = the worst autotomy) after operation and were sacrificed on the 28th day after operation. The L3-6 segment of the spinal cord was removed for determination of the number of neurons (by Nissl's staining) and synapses (by synaptophysin immuno-histochemistry).Results In group S no animal developed autotomy. In group P autotomy started from the 2nd day after operation and the score reached 9-11. The number of the neurons in the spinal dorsal horn in all 4 segments and the number of synapses in L3 and 16 segments were comparable between the two sides and the 2 groups. The number of synapses in the spinal dorsal horn of L4and L5 segment was significantly larger in the operated side than in the contralateral side in group P. Conclusion The number of synapses in the spinal dorsal horn significantly increases in animals with plantom limb pain which induces no increase in the number of neurons in the spinal dorsal horn.%目的 探讨幻肢痛大鼠脊髓背角神经元和突触数量的变化.方法 健康成年SD大鼠11只,雄雌不拘,体重290~300 g,随机分为2组:假手术组(S组,n=5)和单侧坐骨神经横断组(P组,n=6).术后持续观察P组大鼠自噬情况,并进行自噬评分.术后28 d时,取L3~6节段脊髓组织,分别进行尼氏染色(显示神经元)和突触素免疫组织化学染色(显示突触数量),计数手术侧和非手术侧脊髓背角神经元和突触的数量.结果 P

  15. An observational study of the frequency of supernumerary teeth in a population of 2000 patients

    OpenAIRE

    Leco Berrocal, María Isabel; Martín Morales, José F.; Martínez González, José María

    2007-01-01

    An evaluation is made of the epidemiological characteristics of supernumerary teeth, with an analysis of the associated clinical-eruptive complications. A longitudinal observational study was made of 2000 patients, with the documentation of demographic data, the presence of supernumerary teeth, their location, mechanical accidents and the presence of associated pathology. The presence of supernumerary teeth was recorded in 1.05% of the study subjects (mean age 20.2 years), with a greater freq...

  16. Mesiodens with an unusual morphology and multiple impacted supernumerary teeth in a non-syndromic patient.

    Science.gov (United States)

    Srivatsan, Pavithra; Aravindha Babu, N

    2007-01-01

    Supernumerary teeth are a relatively frequent disorder of odontogenesis characterized by an excess number of teeth. Mesiodens is the most common type of supernumerary tooth found in the premaxilla between the two central incisors. They can be supplemental (resembling natural teeth), conical, tuberculate or molariform. We present the case of a 19 year-old girl who presented with a mesiodens of an unusual morphology and multiple impacted supernumerary teeth not associated with any syndrome.

  17. Mesiodens with an unusual morphology and multiple impacted supernumerary teeth in a non-syndromic patient

    Directory of Open Access Journals (Sweden)

    Srivatsan Pavithra

    2007-01-01

    Full Text Available Supernumerary teeth are a relatively frequent disorder of odontogenesis characterized by an excess number of teeth. Mesiodens is the most common type of supernumerary tooth found in the premaxilla between the two central incisors. They can be supplemental (resembling natural teeth, conical, tuberculate or molariform. We present the case of a 19 year-old girl who presented with a mesiodens of an unusual morphology and multiple impacted supernumerary teeth not associated with any syndrome.

  18. Prevalence and characteristics of supernumerary teeth in a non-syndromic South Indian pediatric population

    Directory of Open Access Journals (Sweden)

    Rajesh T Anegundi

    2014-01-01

    Full Text Available Background: Supernumerary teeth are one of the most widely reported and significant anomaly in patients affecting the primary and early mixed dentition. Aim: To describe the distribution and characteristics of the supernumerary teeth in South Indian population of paediatric patients. Design: In a 12 year retrospective study, a total of 63,569 patients up to the age of 14 years who visited our department between June 2003 and May 2013 were revised.790 cases of supernumerary teeth were found. Patients were evaluated for age, sex, site, status of dentition, number, position, orientation and type of supernumerary teeth. Statistical analysis was carried out using chi square test. Results: 790 subjects with supernumerary teeth (481 males and 309 females were detected, revealing male-female ratio of 1.55:1.The most common supernumerary teeth were mesiodens (82.28%, the most common site was the anterior maxilla (92.53%region. Majority of patients had a single erupted supernumerary oriented straight in the arch. Patients in mixed dentition stage reported with maximum number of supernumerary teeth. Conclusions: The prevalence of supernumerary teeth in non syndromicSouth Indian paediatric population is 1.24% with slight male predilection and conical mesiodens being the commonest.

  19. Prevalence and characteristics of supernumerary teeth in a non-syndromic South Indian pediatric population.

    Science.gov (United States)

    Anegundi, Rajesh T; Tegginmani, Veeresh S; Battepati, Prashant; Tavargeri, Anand; Patil, Shruthi; Trasad, Vijay; Jain, Garima

    2014-01-01

    Supernumerary teeth are one of the most widely reported and significant anomaly in patients affecting the primary and early mixed dentition. To describe the distribution and characteristics of the supernumerary teeth in South Indian population of paediatric patients. In a 12 year retrospective study, a total of 63,569 patients up to the age of 14 years who visited our department between June 2003 and May 2013 were revised.790 cases of supernumerary teeth were found. Patients were evaluated for age, sex, site, status of dentition, number, position, orientation and type of supernumerary teeth. Statistical analysis was carried out using chi square test. 790 subjects with supernumerary teeth (481 males and 309 females) were detected, revealing male-female ratio of 1.55:1.The most common supernumerary teeth were mesiodens (82.28%), the most common site was the anterior maxilla (92.53%)region. Majority of patients had a single erupted supernumerary oriented straight in the arch. Patients in mixed dentition stage reported with maximum number of supernumerary teeth. The prevalence of supernumerary teeth in non syndromic South Indian paediatric population is 1.24% with slight male predilection and conical mesiodens being the commonest.

  20. Dentigerous cyst in a child associated with multiple inverted supernumerary teeth: a rare occurrence.

    Science.gov (United States)

    Agrawal, Neeraj K

    2012-01-01

    Dentigerous cysts associated with supernumerary teeth are rare with most of them developing around a mesiodens in the anterior maxilla. Dentigerous cysts from multiple supernumerary teeth, especially with inverted tooth, are rare in other regions of the maxilla. We report a unique case of a dentigerous cyst in a child associated with multiple inverted supernumerary teeth and relevant review of literarature. Dentigerous cyst arising from multiple supernumerary teeth and not anterior maxillary mesiodens is quite uncommon. In a child, such findings associated with inverted tooth are still rare. Such cysts should be managed by excision as soon as possible.

  1. The phantom of the night: restless legs syndrome in amputees.

    Science.gov (United States)

    Giummarra, Melita J; Bradshaw, John L

    2010-06-01

    Chronic pain conditions often "mimic" the symptoms of restless legs syndrome (RLS) with worse pain in the evening and upon rest, associated with an urge to move and relief upon movement. We propose that too little has been made of these parallels, with pain conditions resembling RLS being dismissed as mimics. We found, in a large questionnaire study (n=283) on phantom limb perception, a pattern of phantom pain that resembled RLS: amputees with nocturnal phantom pain were more likely to report worse pain upon rest and/or lying down, with an urge to move the phantom and/or walk to relieve their pain, and to experience spontaneous limb movements akin to periodic leg movements of RLS. We present the hypothesis that a model of restless legs syndrome may provide new insights into the mechanisms underlying phantom pain, and lead to new mechanism-based phantom pain treatment. In particular, central changes associated with sensory and motor symptoms of RLS, neuropathy, and dopamine may also be involved in those predisposed to experience phantom pain that mimics the symptoms of RLS. Ultimately, restless legs syndrome may indeed be a pain syndrome, and warrants further investigation in chronic pain populations. .

  2. 针刺复合星状神经节阻滞治疗外伤性上肢截肢术后幻肢痛效果观察%The effect of combination therapy of nerve block and acupuncture for phantom limb pain by amputation of upper extremity after surgery

    Institute of Scientific and Technical Information of China (English)

    龚琴; 刘莱莉; 罗富荣; 廖荣宗; 高俊青; 陈浩宇

    2014-01-01

    Objective To investigate the effect of combination therapy of nerve block and acupuncture to phantom limb pain of upper extremity after amputation.Methods Eighty patients with phantom limb pain of upper limb were randomly divided into four groups (n=20):20 patients received basic treatment (A group),which included Medications and Psychotherapy,20 patients recieved acupuncture and basic treatment (B group),20 patients recieved nerve block and basic treatment (C group),20 patients recieved nerve block,acupuncture and basic treatment (D group).Scores of VAS,SR-36 and comprehensive comparison of efficacy were used to assess before and after treatment among the four groups.Results visual analogue scales (VAS) scores and SF-36 scores of four groups of patients were significant differences after treatment compared with before treatment (P<0.05).VAS scores decreased after treatment,while SF-36 scores were significantly increased.When compared with A group (52±6),VAS scores of B group (42±8),C group (42±8) and D group (32±6) after treatment decreased significantly,and the differences were statistically significant(P<0.05).Compared with A group(Mental:58±9,Physical:36±5),SF-36 scores of B group(Mental:67±9,Physical:43± 4),C group(Mental:66±6,Physical:43±5) and D group(Mental:77±10,Physical:50±6) after treatment increased significantly,and the differences were statistically significant (P<0.05).When compared with B group and C group,VAS scores of D group decreased significantly after treatment,and SF-36 scores were significantly increased(P<0.05).Comprehensive comparison of efficacy of four groups of patients:After treatment for 5 weeks,compared with A group (70%),there was significant difference in comprehensive comparison of efficacy of B group(85%),C group(85%) and D group(100%) (P<0.05).The results suggest that the treatment effect of B group,C group and D group is better than A group,the treatment effect of D group is best among four groups

  3. Treatment of phantom pain with contralateral injection into tender points: a new method of treatment

    Directory of Open Access Journals (Sweden)

    Alaa A El Aziz Labeeb

    2015-01-01

    Conclusion Contralateral injections of 1 ml of 0.25% bupivacaine in the myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. Our study gives a basis of a new method of management of that kind of severe pain to improve the method of rehabilitation of amputee. However, further longitudinal studies with larger number of patients are needed to confirm our study.

  4. 幻肢痛大鼠脊髓背角小胶质细胞和星形胶质细胞数量的变化%Changes in the number of microglias snd astrocytes in the spinal dorsal horn in a rat model of phantom limb pain

    Institute of Scientific and Technical Information of China (English)

    林菁艳; 彭彬; 杨正伟; 闵苏

    2012-01-01

    Objective To investigate the changes in the number of microglias and astrocytes in the spinal dorsal born in a rat model of phantom limb pain.Methods Eleven healthy adult SD rats of both sexes weighing 290-300 g were randomly divided into 2 groups:sham operation group (group S,n =5 ) and unilateral sciatic nerve transection group (group SNT,n =6).Phantom limb pain model was induced by resection of a 0.5 cm segment of unilateral sciatic nerve in group SNT.In group S unilateral sciatic nerve was exposed but not transected.The animals were observed for autotomy and scored (0 =no autotomy,13 =the worst autotomy) after operation and were sacrificed on the 28th day after operation.The L5 segment of the spinal cord was removed for determination of the number of microglials (by iba-1 immuno-histochemistry) and astrocytes (by GFAP immuno-histochemistry).Results In group S no animal developed autotomy.In group SNT autotomy started from the 2nd day after operation and the score reached 9-11.Compared with group S,the number of the microglias and astrocytes in the spinal dorsal horn was significantly decreased in the operated side in group SNT ( P < 0.05 ).Conclusion The number of microglias and astrocytes in the spinal dorsal horn is decreased in animals with phantom limb pain.%目的 探讨幻肢痛大鼠脊髓背角小胶质细胞和星形胶质细胞数量的变化.方法 健康成年SD大鼠11只,雌雄不拘,体重290~300 g,采用随机数字表法,将其随机分为2组:假手术组(S组,n=5)和单侧坐骨神经横断组(SNT组,n=6).术后持续观察SNT组大鼠自噬情况,并进行自噬评分.术后28d时取L5节段脊髓组织,分别进行iba-1(标记小胶质细胞)及胶质纤维酸性蛋白(标记星形胶质细胞)免疫组化染色,进行手术侧和非手术侧脊髓背角小胶质细胞和星形胶质细胞的计数.结果 S组无一只大鼠发生自噬,SNT组术后2d开始陆续发生自噬,最高自噬评分9~11分.与S组比较,SNT组手术侧脊

  5. Phantom cosmologies and fermions

    CERN Document Server

    Chimento, Luis P; Forte, Monica; Kremer, Gilberto M

    2007-01-01

    Form invariance transformations can be used for constructing phantom cosmologies starting with conventional cosmological models. In this work we reconsider the scalar field case and extend the discussion to fermionic fields, where the "phantomization" process exhibits a new class of possible accelerated regimes.

  6. An EMG Interface for the Control of Motion and Compliance of a Supernumerary Robotic Finger

    Directory of Open Access Journals (Sweden)

    Irfan Hussain

    2016-11-01

    Full Text Available In this paper, we present an electromyographic (EMG control interface for a supernumerary robotic finger. This novel wearable robot can be used to compensate the missing grasping abilities in chronic stroke patients or to augment human healthy hand so to enhance its grasping capabilities and workspace. The proposed EMG interface controls the motion of the robotic extra finger and its joint compliance. In particular, we use a commercial EMG armband for gesture recognition to be associated with the motion control of the robotic device and surface one channel EMG electrodes interface to regulate the compliance of the robotic device. We also present an updated version of a robotic extra finger where the adduction/abduction motion is realized through ball bearing and spur gears mechanism. We validated the proposed interface with two sets of experiments related to compensation and augmentation. In the first set of experiments, different bi-manual tasks have been performed with the help of the robotic device and simulating a paretic hand. In the second set, the robotic extra finger is used to enlarge the workspace and manipulation capability of healthy hands. In both the sets, the same EMG control interface has been used. The obtained results demonstrate that the proposed control interface is intuitive and can successfully be used for both compensation and augmentation purposes. The proposed approach can be exploited also for the control of different wearable devices that has to actively cooperate with the human limbs.

  7. Ownership and Agency of an Independent Supernumerary Hand Induced by an Imitation Brain-Computer Interface.

    Directory of Open Access Journals (Sweden)

    Luke Bashford

    Full Text Available To study body ownership and control, illusions that elicit these feelings in non-body objects are widely used. Classically introduced with the Rubber Hand Illusion, these illusions have been replicated more recently in virtual reality and by using brain-computer interfaces. Traditionally these illusions investigate the replacement of a body part by an artificial counterpart, however as brain-computer interface research develops it offers us the possibility to explore the case where non-body objects are controlled in addition to movements of our own limbs. Therefore we propose a new illusion designed to test the feeling of ownership and control of an independent supernumerary hand. Subjects are under the impression they control a virtual reality hand via a brain-computer interface, but in reality there is no causal connection between brain activity and virtual hand movement but correct movements are observed with 80% probability. These imitation brain-computer interface trials are interspersed with movements in both the subjects' real hands, which are in view throughout the experiment. We show that subjects develop strong feelings of ownership and control over the third hand, despite only receiving visual feedback with no causal link to the actual brain signals. Our illusion is crucially different from previously reported studies as we demonstrate independent ownership and control of the third hand without loss of ownership in the real hands.

  8. Genetics and presence of non-syndromic supernumerary teeth: A mystery case report and review of literature

    OpenAIRE

    Neha Khambete; Rahul Kumar

    2012-01-01

    Presence of supernumerary teeth is well-recognized clinical phenomenon. However, it is uncommon to find multiple supernumeraries in individuals with no other associated disease or syndrome. Presence of multiple supernumerary teeth is thought to have genetic component. We report a rare case where multiple supernumerary teeth were seen without presence of any other syndrome in 3 generations; father, son, and two grandsons. We also present a review of similar cases published in literature till d...

  9. Diagnosis and Surgical Management of Nonsyndromic Nine Supernumerary Teeth and Leong's Tubercle.

    Science.gov (United States)

    Cruz, Christiane V; Soares, Andrea L; Braga, David N; Costa, Marcelo C

    2016-01-01

    Nonsyndromic multiple supernumerary teeth (ST) and Leong's tubercle are a condition with a very low prevalence and a multidisciplinary approach is required to restore function and aesthetics. So, this case report aimed at presenting a rare case of nonsyndromic nine supernumerary teeth and Leong's tubercle in a pediatric patient, without any evident familial history, showing its diagnosis and surgical management.

  10. Radiographic Follow-Up during Orthodontic Treatment for Early Diagnosis of Sequential Supernumerary Teeth

    Science.gov (United States)

    Suga, Uhana Seifert Guimarães; Terada, Raquel Sano Suga

    2016-01-01

    Most supernumerary teeth are impacted and asymptomatic. Objective. The aim of this paper is to describe two cases of sequential development of supernumerary teeth in the mandibular premolar region, identified during orthodontic treatment. Reports. The first case describes the radiographic follow-up of a female patient that presented a supernumerary tooth at the age of 9 years and 10 months in the right mandibular premolar region, followed by a further supernumerary tooth in the left mandibular premolar region identified at the age of 11 years and 3 months. In the second case, the radiographic follow-up of a male patient demonstrated 3 supernumerary teeth in the premolar region at the age of 16 years. During orthognathic surgery planning at the age of 20 years and 5 months, a supplemental supernumerary tooth was found in the left mandibular region. Conclusion. Considering the late developing of supernumerary premolars, appropriate follow-up with panoramic radiographs of patients with previous experience of supernumerary teeth is essential for early diagnosis of supplemental premolars to prevent possible complications. PMID:27313911

  11. Prevalence of impacted and supernumerary teeth in the North Indian population.

    Science.gov (United States)

    Patil, Santosh; Maheshwari, Sneha

    2014-04-01

    Dental impaction is a very frequent problem. Supernumerary teeth, or hyperdontia, are the presence of additional teeth to the normal series in the either of the dentition. The presence of impacted and/or supernumerary teeth can cause various complications. The objective of the present study was to determine the prevalence of impacted and supernumerary teeth in the North Indian population. The panoramic radiographic records of 4750 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 to December 2012 were examined for this retrospective study. The ages of the patients ranged from 8 to 72 years, with a mean of 34.6 years. A total of 798 (16.8%) patients presented with 1126 impacted teeth. Impacted canines were the most prevalent (9.7%), followed by impacted premolars (4.3%). Supernumerary teeth (1.6%) and impacted molars (1.2%) were less prevalent. Among the 842 impacted teeth, the most frequently affected teeth were the canines (56.7%), followed by premolars (27.8%), and supernumerary teeth (9.3%), while the prevalence of impacted molars was quite lower (6.2%). The most frequently impacted teeth were maxillary canines and the mesiodens were the most common supernumerary tooth. The early diagnosis of supernumerary and impacted teeth is essential to prevent malocclusion and malalignment of permanent teeth demonstrating the importance of panoramic radiographs in their detection. Key words:Impacted, supernumerary, prevalence, canines, mesiodens.

  12. Mirror therapy in lower limb amputees--a look beyond primary motor cortex reorganization.

    Science.gov (United States)

    Seidel, S; Kasprian, G; Furtner, J; Schöpf, V; Essmeister, M; Sycha, T; Auff, E; Prayer, D

    2011-11-01

    Phantom pain in upper limb amputees is associated with the extent of reorganization in the primary sensorimotor cortex. Mirror visual feedback therapy has been shown to improve phantom pain. We investigated the extent of cortical reorganization in lower limb amputees and changes in neural activity induced by mirror therapy. Eight lower limb amputees underwent 12 sessions of MVFT and functional magnetic resonance imaging (fMRI) of the brain before the first and after the last MVFT session. FMRI sessions consisted of two runs in which subjects were instructed to perform repetitive movement of the healthy and phantom ankle. Before MVFT, the mean phantom pain intensity was 4.6 ± 3.1 on a visual analog scale and decreased to 1.8 ± 1.7 (p = 0.04). We did not observe a consistent pattern of cortical activation in primary sensorimotor areas during phantom limb movements. Following MVFT, increased activity was obtained in the right orbitofrontal cortex during phantom ankle movements. Comparison of cortical activity during movements of the phantom ankle and the intact ankle showed significantly higher activity in the left inferior frontal cortex (pars triangularis). These results question the known association between phantom pain and primary sensorimotor reorganization and propose reorganizational changes involving multiple cortical areas in lower limb amputees. Finally, reduction of phantom pain after mirror visual feedback therapy was associated with increased prefrontal cortical activity during phantom ankle movements. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Mirror therapy in lower limb amputees. A look beyond primary motor cortex reorganization

    Energy Technology Data Exchange (ETDEWEB)

    Seidel, S.; Essmeister, M.; Sycha, T.; Auff, E. [Vienna Medical Univ. (Austria). Dept. of Neurology; Kasprian, G.; Furtner, J.; Schoepf, V.; Prayer, D. [Vienna Medical Univ. (Austria). Dept. of Neuroradiology

    2011-11-15

    Phantom pain in upper limb amputees is associated with the extent of reorganization in the primary sensorimotor cortex. Mirror visual feedback therapy has been shown to improve phantom pain. We investigated the extent of cortical reorganization in lower limb amputees and changes in neural activity induced by mirror therapy. Eight lower limb amputees underwent 12 sessions of MVFT and functional magnetic resonance imaging (fMRI) of the brain before the first and after the last MVFT session. FMRI sessions consisted of two runs in which subjects were instructed to perform repetitive movement of the healthy and phantom ankle. Before MVFT, the mean phantom pain intensity was 4.6 {+-} 3.1 on a visual analog scale and decreased to 1.8 {+-} 1.7 (p = 0.04). We did not observe a consistent pattern of cortical activation in primary sensorimotor areas during phantom limb movements. Following MVFT, increased activity was obtained in the right orbitofrontal cortex during phantom ankle movements. Comparison of cortical activity during movements of the phantom ankle and the intact ankle showed significantly higher activity in the left inferior frontal cortex (pars triangularis). These results question the known association between phantom pain and primary sensorimotor reorganization and propose reorganizational changes involving multiple cortical areas in lower limb amputees. Finally, reduction of phantom pain after mirror visual feedback therapy was associated with increased prefrontal cortical activity during phantom ankle movements. (orig.)

  14. Prevalence of supernumerary teeth in a nonsyndromic Syrian sample.

    Science.gov (United States)

    Burhan, Ahmad S; Nawaya, Fehmieh R; Arabi Katbi, Mohammad E; Al-Jawabra, Alaa S

    2015-12-01

    Supernumerary teeth (ST), also known as hyperdontia, is a condition in which more than the normal number of teeth are present in the series. The prevalence of ST varies between and within different populations. These teeth may cause various complications. The aim of the current study was to investigate the prevalence and characteristics of ST in Damascus inhabitants, Syria. A cross-sectional study was carried out using retrospectively collected digital panoramic radiographs of 2753 patients (1047 males and 1706 females) ranging in age from 12.2 to 20.5 years between January 2012 and December 2014. These radiographs were obtained from private dental offices spread across Damascus, Syria. For each patient with ST, the demographic variables, number, location, type, position, morphology of ST, and complications were recorded. ST were detected in 39 patients (1.4%), of whom 25 (64.1%) were males and 14 (35.9%) were females, with a male to female ratio of 1.8 : 1 (PMesiodens was the most prevalent ST (39.1%), followed by supernumerary premolars (28.3%), supernumerary laterals (26.1%), distomolars (4.3%), and paramolars (2.2%). This series includes cases with one and two ST. Of the 46 ST detected, 56.5% had a conical morphology, 89.1% were in a vertical position, and 19.6% were erupted. ST caused displacement of the adjacent teeth in 17 cases (37.0%) and the impaction of the permanent teeth in five cases (10.9%). The prevalence of ST in Damascus inhabitants was found to be 1.4%; the most frequent type was mesiodens. A conical morphology was found to be the most common form of ST. Displacement of permanent teeth is the most frequent complication. Further studies should be carried out on more representative samples of both the public and the private sector patients.

  15. Non-syndromic multiple supernumerary premolars: Clinicoradiographic report of five cases

    Directory of Open Access Journals (Sweden)

    Renu Tanwar

    2017-03-01

    Full Text Available Hyperdontia or supernumerary teeth in both arches without any syndromic manifestation are extremely rare. Supernumerary teeth are commonly associated with Gardner’s syndrome, cleft lip and palate, cleidocranial dysplasia and trichorhinopha-langeal syndrome. Five cases of non-syndromic multiple premolars of maxillary and mandibular arches in Indian patients are presented here. This case series reports three cases with multiple (9 in maximum, bilaterally impacted and erupted supernumerary teeth and two cases with supernumerary premolars in non-syndromic cases from Indian patients. Supernumerary teeth can be present in any region of the oral cavity. Although the occurrence of maxillary para-premolars is rare, radio-logical investigations play a major and decisive role in determining the management of such cases.

  16. The study of impacted and supernumerary teeth in young man by the full mouth roentgenograms

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Hung Kyu [Department of Dental Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1977-11-15

    The author has observed 906 full mouth roentgenograms in Korean young man who had the impacted and supernumerary teeth. Impacted and supernumerary teeth were analysed upon several items, such as incidences and positions in the dental arch . The results were as follows; 1. The incidences of impacted teeth were 59.05%, and the ratio of upper jaw to lower one was 1:3. 2. The frequency of the supernumerary teeth were 5.52%, and the ratio of maxilla to mandible was 49:1. 3. No significant differences between right and left side in both jaws, but incidence rate of the supernumerary teeth was 74% in the maxillary central incisor area. 4. The positions of impacted and supernumerary teeth were vertical and inverted shapes in maxilla, whereas horizontal a nd mesio-angular forms in mandible.

  17. Cystic Endometrioma with Coexisting Fibroma Originating in a Supernumerary Ovary in the Rectovaginal Pouch

    Science.gov (United States)

    Sakaguchi, Asumi; Kodama, Hiroko; Ogura, Kanako; Miwa, Ayako; Sugimori, Yayoi; Matuoka, Shozo; Matsumoto, Toshiharu

    2017-01-01

    A supernumerary ovary is an exceedingly rare disorder, in which the structure containing ovarian tissue is located at some distance from the normally placed ovary. 16 cases of endometriosis or tumors originating in a supernumerary ovary have been published in the English literature, but no case of coexisting endometriosis and a tumor has been published. We present the case of a 40-year-old female with cystic endometrioma with coexisting fibroma originating in a supernumerary ovary in the rectovaginal pouch. The present case is the first to be reported with coexisting endometriosis and a tumor originating in a supernumerary ovary. Our experience with this case and the results of our previous studies of rectovaginal endometriosis indicated that the possibility of originating in a supernumerary ovary shall be examined in cases of cystic endometrioma in the rectovaginal pouch. PMID:28210515

  18. Múltiples dientes supernumerarios distomolares Multiple distomolars supernumerary teeth

    OpenAIRE

    F.J. Rodríguez Romero; S. Cerviño Ferradanes

    2009-01-01

    En una dentición normal, los dientes supernumerarios son aquellos descritos como adicionales a la serie. La etiología no esta clara. Se han descritos tanto en dentición primaria como en permanente, aunque son mas frecuentes en la dentición permanente. El objetivo de este informe es presentar un caso de una paciente con múltiples dientes supernumerarios distomolares. Cuartos molares bilaterales simétricos son sumamente raros.Supernumerary teeth are described as the teeth formed in excess of th...

  19. On the syndrome of the "spare limb": one case.

    Science.gov (United States)

    Grossi, Dario; Di Cesare, Gabriela; Tamburro, Rosario Paolo

    2002-04-01

    We describe a case of a brain-damaged patient who had a peculiar bodily illusion which could not be labelled an hallucination but seemed somatognosically and phenomenologically similar to the phantom limb without amputation. The patient, who showed left hemiplegia, felt a third upper limb (without seeing it) which he himself defined as "spare." The spare limb was not deformed; it could be moved and controlled by the patient, and there was no sensation of pain. The patient did not show psychopathological or cognitive disorders. A possible interpretation of the phenomenon is as a "phantom movement" of the paralysed limb: the mental representation of the movement of the limb was dissociated from the bodily representation of his own limb and so was still present in his consciousness despite the paralysis.

  20. Genetics and presence of non-syndromic supernumerary teeth: A mystery case report and review of literature.

    Science.gov (United States)

    Khambete, Neha; Kumar, Rahul

    2012-10-01

    Presence of supernumerary teeth is well-recognized clinical phenomenon. However, it is uncommon to find multiple supernumeraries in individuals with no other associated disease or syndrome. Presence of multiple supernumerary teeth is thought to have genetic component. We report a rare case where multiple supernumerary teeth were seen without presence of any other syndrome in 3 generations; father, son, and two grandsons. We also present a review of similar cases published in literature till date. The role of genetics in development of supernumerary teeth is highlighted.

  1. Genetics and presence of non-syndromic supernumerary teeth: A mystery case report and review of literature

    Directory of Open Access Journals (Sweden)

    Neha Khambete

    2012-01-01

    Full Text Available Presence of supernumerary teeth is well-recognized clinical phenomenon. However, it is uncommon to find multiple supernumeraries in individuals with no other associated disease or syndrome. Presence of multiple supernumerary teeth is thought to have genetic component. We report a rare case where multiple supernumerary teeth were seen without presence of any other syndrome in 3 generations; father, son, and two grandsons. We also present a review of similar cases published in literature till date. The role of genetics in development of supernumerary teeth is highlighted.

  2. Surgical management of multiple supernumerary teeth and an impacted maxillary permanent central incisor.

    Science.gov (United States)

    Rallan, Mandeep; Rallan, Neelakshi Singh; Goswami, Mousumi; Rawat, Kamini

    2013-05-22

    Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. It is a developmental anomaly and has been argued to arise from multiple aetiologies. The most common site is the maxillary incisor region; but the prevalence of more than three teeth supernumerary tooth is less than 1%. A case of 13 year male patient is reported with a multiple impacted supernumerary tooth in maxillary anterior region hindering the eruption of right permanent central incisor. The supernumerary tooth was treated via surgical approach followed by an interim prosthesis for permanent central incisor which later on erupted in due course of time. Background Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. The presence of supernumerary teeth in the premaxillary region often poses unique diagnostic and managerial concerns for the practitioner. Rarely is the surplus number compensated by an absence or deficiency of other teeth. Therefore, the dysfunctional nature of supernumerary teeth and their ability to create a variety of pathological disturbances in the normal eruption and position of adjacent teeth warrants their early detection and prudent management. Approximately 76-86% of cases represent single-tooth hyperdontia, with two supernumerary teeth noted in 12-23% and three or more extra teeth noted in less than 1% of cases. Multiple supernumerary teeth are also associated with many syndromes like cleidocranial dysplasia and Gardner’s syndrome etc. However, it is rare to find multiple supernumeraries in individuals with no other associated disease or syndrome. In such cases, the maxillary anterior region is the common site of occurrence. The exact aetiology is not clearly understood. The supernumerary teeth result from any disturbance in the initiation and proliferation stages of odontogenesis. There are several theories regarding the

  3. 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....

  4. 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 ...

  5. The Potency of Optical and Augmented Reality Mirror Boxes in Amputees and People with Intact Limbs

    Directory of Open Access Journals (Sweden)

    Kieran O'Neill

    2006-01-01

    Full Text Available Phantom limb pain is the distressing problem experienced by many amputees, defined as a painful sensation perceived in the area of the missing body part. Phantom limb pain can be very severe and disabling. It continues to be experienced by two thirds of amputees, eight years post-amputation. Augmented reality has the ability to change a person’s sensory experience. More applications of this technology are gradually being utilised for therapeutic purposes as augmented environments can be used both to distract the attention of patients from excruciatingly painful experiences and to promote cortical re-mapping at the site from where the pain arises. Using Augmented Reality, an environment has been created where upper limb amputees can both view and control motion of their phantom limb to help alleviate phantom limb pain.

  6. Multiple supernumerary teeth and odontoma in the maxilla: A case report

    Directory of Open Access Journals (Sweden)

    P B Sood

    2010-01-01

    Full Text Available Most supernumerary impacted teeth are located in the anterior maxillary region. They are classified according to their form and location. Their presence may give rise to a variety of clinical problems. The detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. This article presents an overview of the diagnostic problems associated with multiple supernumerary impacted teeth and includes a discussion of the classification, diagnosis, and management of this difficult clinical entity.

  7. Multiple supernumerary teeth associated with an impacted maxillary central incisor: Surgical and orthodontic management

    Directory of Open Access Journals (Sweden)

    Ramakrishna Yeluri

    2012-01-01

    Full Text Available Various anomalies in the size, shape, number, structure and eruption of the teeth are often observed clinical conditions. Supernumerary teeth can be found in almost any region of the dental arch, and most of the times they are asymptomatic, and are routinely found during radiographic evaluation. The most common cause of impacted maxillary incisors is the presence of the supernumerary teeth. This paper describes a case of multiple supernumerary teeth associated with an impacted permanent maxillary central incisor in an 11-year old child along with its surgical and orthodontic management.

  8. Supernumerary ring chromosome: an etiology for Pallister-Killian syndrome?

    Science.gov (United States)

    Lloveras, E; Canellas, A; Cirigliano, V; Català, V; Cerdan, C; Plaja, A

    2013-01-01

    Characterization of marker chromosomes before the introduction of array CGH (aCGH) assays was only based on their banding patterns (G, C, and NOR staining) and fluorescent in situ hybridization techniques. The use of aCGH greatly improves the identification of marker chromosomes in some cases. We describe an atypical case of Pallister-Killian syndrome (PKS) detected at prenatal diagnosis with a very unusual cytogenetic presentation: a supernumerary ring chromosome including two copies of 12p. A similar anomaly described in a postnatal patient suggests ring chromosome as a possible cause of PKS. Extra ring chromosomes might be a more common etiology for PKS than previously thought, given the difficulty in their characterization before the advent of aCGH.

  9. Four miniature kidneys: supernumerary kidney and multiple organ system anomalies.

    Science.gov (United States)

    Afrouzian, Marjan; Sonstein, Joseph; Dadfarnia, Tahereh; Sreshta, J Nicholas; Hawkins, Hal K

    2014-05-01

    More than 350 years after Martius's first reported case in 1656, supernumerary kidney (SNK) continues to fascinate the world of medicine, generating new ideas in the domain of embryogenesis. Association of a normal kidney with a second or third ipsilateral smaller kidney is an extremely rare anomaly with only a total of 81 cases reported until today. We are reporting a case of SNK, clinically diagnosed as right hydronephrosis, associated with an ipsilateral ectopic ureter, a contralateral partially duplicated ureter, and a multiseptate gallbladder. Pathologic examination of the nephrectomy revealed 4 miniature kidneys, joining a dilated ureter through 4 separate conduits. Our patient is the first reported case of SNK with absent ipsilateral normal kidney, presence of more than 3 kidneys on 1 side, and associated anomaly in the gallbladder. This case represents a unique combination of rarities, suggesting insights in the domain of molecular embryology.

  10. Motor cortex representation of the upper-limb in individuals born without a hand.

    Directory of Open Access Journals (Sweden)

    Karen T Reilly

    Full Text Available The body schema is an action-related representation of the body that arises from activity in a network of multiple brain areas. While it was initially thought that the body schema developed with experience, the existence of phantom limbs in individuals born without a limb (amelics led to the suggestion that it was innate. The problem with this idea, however, is that the vast majority of amelics do not report the presence of a phantom limb. Transcranial magnetic stimulation (TMS applied over the primary motor cortex (M1 of traumatic amputees can evoke movement sensations in the phantom, suggesting that traumatic amputation does not delete movement representations of the missing hand. Given this, we asked whether the absence of a phantom limb in the majority of amelics means that the motor cortex does not contain a cortical representation of the missing limb, or whether it is present but has been deactivated by the lack of sensorimotor experience. In four upper-limb amelic subjects we directly stimulated the arm/hand region of M1 to see 1 whether we could evoke phantom sensations, and 2 whether muscle representations in the two cortices were organised asymmetrically. TMS applied over the motor cortex contralateral to the missing limb evoked contractions in stump muscles but did not evoke phantom movement sensations. The location and extent of muscle maps varied between hemispheres but did not reveal any systematic asymmetries. In contrast, forearm muscle thresholds were always higher for the missing limb side. We suggest that phantom movement sensations reported by some upper limb amelics are mostly driven by vision and not by the persistence of motor commands to the missing limb within the sensorimotor cortex. We propose that prewired movement representations of a limb need the experience of movement to be expressed within the primary motor cortex.

  11. Endoscopic Removal of a Supernumerary Premolar in the Mandible during a Dental Implant Placement

    Directory of Open Access Journals (Sweden)

    Víctor Beltrán

    2014-01-01

    Full Text Available The surgical removal of supernumerary teeth is necessary in some cases, especially before the commencement of any orthodontic or implant treatment procedure. In the mandibular supernumerary premolar, a more conservative approach is required because of the presence of complications associated with conventional surgery due to the close proximity of the said premolar to the alveolar inferior and mental nerves, and the need for bone conservation for implant placement. The endoscopic surgical approach has been used for the removal of the maxillary supernumerary tooth, impacted third molar, and implants. In this case report, we present an endoscopically assisted surgical technique for the removal of an unerupted supernumerary premolar in the mandible associated with a dental implant placement procedure.

  12. Agenesis of premolar associated with submerged primary molar and a supernumerary premolar: An unusual case report

    Directory of Open Access Journals (Sweden)

    S. V. S. G. Nirmala

    2012-01-01

    Full Text Available The combination of submerged primary molar, agenesis of permanent successor with a supernumerary in the same place is very rare. The purpose of this article is to report a case of submerged mandibular left second primary molar with supernumerary tooth in the same region along with agenesis of second premolar in an 11-year-old girl, its possible etiological factors, and a brief discussion on treatment options.

  13. Diagnosis and management of supernumerary (mesiodens): a review of the literature.

    Science.gov (United States)

    Meighani, G; Pakdaman, A

    2010-01-01

    Supernumerary tooth is one of the developmental problems in children. Mesiodens is a supernumerary tooth present in the midline between the two central incisors. It usually results in oral problems such as malocclusion, food impaction, poor aesthetics, and cyst formation. The prevalence of mesiodens varies between 0.09% and 2.05% in different studies. This paper reviews current literature on etiology, prevalence, diagnosis, and management of this problem. Accordingly, early diagnosis and treatment is suggested to prevent orthodontic and pathologic complications.

  14. Coexistent partial anodontia and supernumerary tooth in the mandibular arch: A rare case

    Directory of Open Access Journals (Sweden)

    Das G

    2006-05-01

    Full Text Available Coexistent partial anodontia and supernumerary tooth in the lower jaw is a very uncommon condition. Very few cases have been reported in the literature of this condition, etiology of which is still obscure. Presented here is a rare case of simultaneous presence of single supernumerary tooth together with missing permanent central incisor teeth in the lower jaw without any associated systemic condition or syndrome.

  15. Jamitons: Phantom Traffic Jams

    Science.gov (United States)

    Kowszun, Jorj

    2013-01-01

    Traffic on motorways can slow down for no apparent reason. Sudden changes in speed by one or two drivers can create a chain reaction that causes a traffic jam for the vehicles that are following. This kind of phantom traffic jam is called a "jamiton" and the article discusses some of the ways in which traffic engineers produce…

  16. Jamitons: Phantom Traffic Jams

    Science.gov (United States)

    Kowszun, Jorj

    2013-01-01

    Traffic on motorways can slow down for no apparent reason. Sudden changes in speed by one or two drivers can create a chain reaction that causes a traffic jam for the vehicles that are following. This kind of phantom traffic jam is called a "jamiton" and the article discusses some of the ways in which traffic engineers produce…

  17. The Phantom brane revisited

    Science.gov (United States)

    Sahni, Varun

    2016-07-01

    The Phantom brane is based on the normal branch of the DGP braneworld. It possesses a phantom-like equation of state at late times, but no big-rip future singularity. In this braneworld, the cosmological constant is dynamically screened at late times. Consequently it provides a good fit to SDSS DR11 measurements of H(z) at high redshifts. We obtain a closed system of equations for scalar perturbations on the brane. Perturbations of radiation, matter and the Weyl fluid are self-consistently evolved until the present epoch. We find that the late time growth of density perturbations on the brane proceeds at a faster rate than in ΛCDM. Additionally, the gravitational potentials φ, Ψ evolve differently on the brane than in ΛCDM, for which φ = Ψ. On the Brane, by contrast, the ratio φ/Ψ exceeds unity during the late matter dominated epoch (z ≤ 50). These features emerge as smoking gun tests of phantom brane cosmology and allow predictions of this scenario to be tested against observations of galaxy clustering and large scale structure. The phantom brane also displays a pole in its equation of state, which provides a key test of this dark energy model.

  18. Histological Evaluation and Management of Rare Case of Supernumerary “Ghost” Teeth

    Directory of Open Access Journals (Sweden)

    Dino Re

    2017-01-01

    Full Text Available Supernumerary teeth are teeth that exceed the normal dental formula. Their prevalence in the permanent dentition is 1–14% and they occur more frequently in maxilla with a sex ratio of 2 : 1 in favor of males. They are often associated with syndromes but there are examples of nonsyndromic multiple supernumerary teeth reported in the literature. CBCT is usually the best exam for radiographic diagnosis and treatment planning, because it provides 3D information about location and morphology of supernumerary teeth. This paper reports a rare case of four supernumerary teeth in a nonsyndromic 9-year-old boy. The peculiarity of this case is that two more exceeding teeth were found during surgical procedure. After extraction, all the teeth underwent a histological undecalcified processing for light microscopical examination. The two “ghost” supernumerary teeth seemed to be primordial dental germs, possibly resulting from an altered odontogenic process. After supernumerary teeth extraction, X-rays and exfoliation monitoring are recommended, since permanent retained teeth often erupt naturally or, at least, improve their condition. Radiographic follow-up is also useful in order to assess the formation of further teeth due to the hyperactivity of the dental lamina.

  19. Prevalence rate of supernumerary teeth among non-syndromic South Indian population: An analysis

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    M Nazargi Mahabob

    2012-01-01

    Full Text Available Aim: Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stage. The main objective of the study was to determine the prevalence rate of supernumerary teeth in the patients who reported to the Department of Oral Medicine and Radiology and to study the associated clinical complications. Materials and Methods: A longitudinal observational study was conducted of 2216 patients for a period of 4 months with the documentation of demographic data, the presence of supernumerary teeth, their location, and associated complications such as mechanical trauma, dental caries, and associated pathology. Results: The study recorded 27 supernumerary teeth from the examined 2216 patients. This yields a prevalence of 1.2%, with greater frequency in males which was 1.49% and in females the frequency was 0.85%. The greatest proportion of supernumerary teeth was found in the maxillary anterior region (77.8%. Out of this, 85.7% were classified as mesiodens based on their location. The displacement of adjacent teeth was the most common finding, followed by dental caries. Conclusion: The prevalence of supernumerary teeth in this study was 1.2% which is in agreement with that reported in similar studies and the maxillary mesiodens was the most common location. Displacement of adjacent teeth was the most common finding.

  20. Prevalence rate of supernumerary teeth among non-syndromic South Indian population: An analysis.

    Science.gov (United States)

    Mahabob, M Nazargi; Anbuselvan, G J; Kumar, B Senthil; Raja, S; Kothari, Sucitha

    2012-08-01

    Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stage. The main objective of the study was to determine the prevalence rate of supernumerary teeth in the patients who reported to the Department of Oral Medicine and Radiology and to study the associated clinical complications. A longitudinal observational study was conducted of 2216 patients for a period of 4 months with the documentation of demographic data, the presence of supernumerary teeth, their location, and associated complications such as mechanical trauma, dental caries, and associated pathology. The study recorded 27 supernumerary teeth from the examined 2216 patients. This yields a prevalence of 1.2%, with greater frequency in males which was 1.49% and in females the frequency was 0.85%. The greatest proportion of supernumerary teeth was found in the maxillary anterior region (77.8%). Out of this, 85.7% were classified as mesiodens based on their location. The displacement of adjacent teeth was the most common finding, followed by dental caries. The prevalence of supernumerary teeth in this study was 1.2% which is in agreement with that reported in similar studies and the maxillary mesiodens was the most common location. Displacement of adjacent teeth was the most common finding.

  1. The post-natal fate of supernumerary ribs in rat teratogenicity studies.

    Science.gov (United States)

    Wickramaratne, G A

    1988-04-01

    A common occurrence in rat teratology studies, supernumerary ribs, have been considered to be indicative of teratogenicity by some authors but not to be so indicative by others. As a teratogenic event is, by definition a permanent change, a study to follow the fate of supernumerary ribs in the development of adulthood of the rat was undertaken. An established teratogen in the rat, aspirin, was used to increase the frequency of supernumerary ribs. Even though aspirin treatment of the dams doubled the initial frequency of supernumerary ribs the results show that over the first 60 days post-partum their frequency in both control and treated groups decline to essentially zero. This decline in frequency of supernumerary ribs is complemented by an increase in the proportion of foetuses with a fully developed transverse process on the first lumbar vertebra. The proposal that supernumerary ribs in the rat are a result of developmental delays in a labile region of the axial skeleton and not a manifestation of a teratogenic event is presented.

  2. Fine mapping of a supernumerary proleg mutant (E(Cs) -l) and comparative expression analysis of the abdominal-A gene in silkworm, Bombyx mori.

    Science.gov (United States)

    Chen, P; Tong, X-L; Li, D-D; Liang, P-F; Fu, M-Y; Li, C-F; Hu, H; Xiang, Z-H; Lu, C; Dai, F-Y

    2013-10-01

    Patterning and phenotypic variations of appendages in insects provide important clues on developmental genetics. In the silkworm Bombyx mori, morphological variations associated with the E complex, an analogue of the Drosophila melanogaster bithorax complex, mainly determine the shape and number of prolegs on abdominal segments. Here, we report the identification and characterization of the allele responsible for the supernumerary crescents and legs-like (E(Cs) -l) mutant, a model derived from spontaneous mutation of the E complex, with supernumerary legs and extra crescents. Fine mapping with 1605 individuals revealed a ∼68 kb sequence in the upstream intergenic region of B. mori abdominal-A (Bmabd-A) clustered with the E(Cs) -l locus. Quantitative real-time PCR (qRT-PCR) and Western blotting analyses disclosed a marked increase in Bmabd-A expression in the E(Cs) -l mutant at both the transcriptional and translational levels, compared to wild-type Dazao. Furthermore, we observed ectopic expression of the Bmabd-A protein in the second abdominal segment (A2) of the E(Cs) -l mutant. Our results collectively suggest that the 68 kb region contains important regulatory elements of the Bmabd-A gene, and provide evidence that the gene is required for limb development in abdominal segments in the silkworm.

  3. INVESTIGATION OF IMPACTED SUPERNUMERARY TEETH: A CONE BEAM COMPUTED TOMOGRAPH (CBCT STUDY

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    Gökhan GÜRLER

    2017-10-01

    Full Text Available Purpose: The purpose of this study was to investigate the impacted supernumerary teeth which were initially detected on panoramic radiographs by using cone beam computed tomography (CBCT. Materials and Methods: In this retrospective study, supernumerary teeth diagnosed on panoramic radiographs taken from patients who had admitted for routine dental treatment were evaluated using CBCT. Patients’ age, gender, systemic conditions as well as number of supernumerary teeth, unilateral-bilateral presence, anatomical localization (maxilla, mandible, anterior-premolar-molar, mesiodens-lateral-canine, parapremolar-paramolar-distomolar shape (rudimentary, supplemental, tuberculate, odontoma, position (palatal-lingual-buccal-labial-central, shortest distance between the tooth and adjacent cortical plate, complications and treatment were assessed. Results: A total of 47 impacted supernumerary teeth in 34 patients were investigated in this study. Of these, 33 (70.2% were unilateral and 14 (29.8% were bilateral. Only 1 supernumerary tooth was found in 27 patients (79.4% whereas 7 patients (20.6% had 2 or more supernumerary teeth. Most of the teeth located in the anterior region (74.4% of the jaws and maxilla (74.4%. Twenty teeth (42.5% were mesiodens, 11 (23.4% were lateral or canine, 14 (29.7% were parapremolar and 2(4.4% were distomolar. Twenty-seven teeth (57.4% were rudimentary, 15 (31.9% were supplemental and 5 (10.7% were odontoma in shape. The shortest distance between the supernumerary tooth and adjacent cortical plate varied between 0 to 2.5 mm with a mean of 0.66 mm. The most common clinical complaint was the non-eruption of permanent teeth (42.5%. All supernumerary teeth were removed under local anesthesia. Orthodontic traction was performed for those impacted permanent teeth if necessary. Conclusion: Impacted supernumerary teeth are usually in close proximity to cortical bone. Although this may facilitate surgical access, there is a risk of

  4. [Phantom holder of CT couch].

    Science.gov (United States)

    Zhang, Ruixia; Zhan, Hongyu; Wang, Di

    2014-03-01

    This article describes a phantom holder in CT couch which adjusted easily and accurately, installed easily. The holder mainly include removing and locking equipment between phantom holder and table top, move horizontally equipment between left and right, rotating equipment between left and right. After holder and table top fixed one part, holder with phantom can move horizontally, front and back, rotate between left and right in a small angle, in order to make operator test phantoms accurately and easily. At the same time, this phantom holder realized free adjustment after first adjustments, which shortened operator work time.

  5. Tissue-like phantoms

    Science.gov (United States)

    Frangioni, John V.; De Grand, Alec M.

    2007-10-30

    The invention is based, in part, on the discovery that by combining certain components one can generate a tissue-like phantom that mimics any desired tissue, is simple and inexpensive to prepare, and is stable over many weeks or months. In addition, new multi-modal imaging objects (e.g., beads) can be inserted into the phantoms to mimic tissue pathologies, such as cancer, or merely to serve as calibration standards. These objects can be imaged using one, two, or more (e.g., four) different imaging modalities (e.g., x-ray computed tomography (CT), positron emission tomography (PET), single photon emission computed tomography (SPECT), and near-infrared (NIR) fluorescence) simultaneously.

  6. The Phantom SPH code

    Science.gov (United States)

    Price, Daniel; Wurster, James; Nixon, Chris

    2016-05-01

    I will present the capabilities of the Phantom SPH code for global simulations of dust and gas in protoplanetary discs. I will present our new algorithms for simulating both small and large grains in discs, as well as our progress towards simulating evolving grain populations and coupling with radiation. Finally, I will discuss our recent applications to HL Tau and the physics of dust gap opening.

  7. Somatic Mosaicism in Cases with Small Supernumerary Marker Chromosomes

    Science.gov (United States)

    Liehr, Thomas; Karamysheva, Tatyana; Merkas, Martina; Brecevic, Lukrecija; Hamid, Ahmed B.; Ewers, Elisabeth; Mrasek, Kristin; Kosyakova, Nadezda; Weise, Anja

    2010-01-01

    Somatic mosaicism is something that is observed in everyday lives of cytogeneticists. Chromosome instability is one of the leading causes of large-scale genome variation analyzable since the correct human chromosome number was established in 1956. Somatic mosaicism is also a well-known fact to be present in cases with small supernumerary marker chromosomes (sSMC), i.e. karyotypes of 47,+mar/46. In this study, the data available in the literature were collected concerning the frequency mosaicism in different subgroups of patients with sSMC. Of 3124 cases with sSMC 1626 (52%) present with somatic mosaicism. Some groups like patients with Emanuel-, cat-eye- or i(18p)- syndrome only tend rarely to develop mosaicism, while in Pallister-Killian syndrome every patient is mosaic. In general, acrocentric and non-acrocentric derived sSMCs are differently susceptible to mosaicism; non-acrocentric derived ones are hereby the less stable ones. Even though, in the overwhelming majority of the cases, somatic mosaicism does not have any detectable clinical effects, there are rare cases with altered clinical outcomes due to mosaicism. This is extremely important for prenatal genetic counseling. Overall, as mosaicism is something to be considered in at least every second sSMC case, array-CGH studies cannot be offered as a screening test to reliably detect this kind of chromosomal aberration, as low level mosaic cases and cryptic mosaics are missed by that. PMID:21358988

  8. Small supernumerary marker chromosomes and their correlation with specific syndromes

    Science.gov (United States)

    Jafari-Ghahfarokhi, Hamideh; Moradi-Chaleshtori, Maryam; Liehr, Thomas; Hashemzadeh-Chaleshtori, Morteza; Teimori, Hossein; Ghasemi-Dehkordi, Payam

    2015-01-01

    A small supernumerary marker chromosome (sSMC) is a structurally abnormal chromosome. It is an additional chromosome smaller than one chromosome most often lacking a distinct banding pattern and is rarely identifiable by conventional banding cytogenetic analysis. The origin and composition of an sSMC is recognizable by molecular cytogenetic analysis. These sSMCs are seen in different shapes, including the ring, centric minute, and inverted duplication shapes. The effects of sSMCs on the phenotype depend on factors such as size, genetic content, and the level of the mosaicism. The presence of an sSMC causes partial tris- or tetrasomy, and 70% of the sSMC carriers are clinically normal, while 30% are abnormal in some way. In 70% of the cases the sSMC is de novo, in 20% it is inherited from the mother, and in 10% it is inherited from the father. An sSMC can be causative for specific syndromes such as Emanuel, Pallister-Killian, or cat eye syndromes. There may be more specific sSMC-related syndromes, which may be identified by further investigation. These 10 syndromes can be useful for genetic counseling after further study. PMID:26322288

  9. Multiple forms of atypical rearrangements generating supernumerary derivative chromosome 15

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    Sigman Marian

    2008-01-01

    Full Text Available Abstract Background Maternally-derived duplications that include the imprinted region on the proximal long arm of chromosome 15 underlie a complex neurobehavioral disorder characterized by cognitive impairment, seizures and a substantial risk for autism spectrum disorders1. The duplications most often take the form of a supernumerary pseudodicentric derivative chromosome 15 [der(15] that has been called inverted duplication 15 or isodicentric 15 [idic(15], although interstitial rearrangements also occur. Similar to the deletions found in most cases of Angelman and Prader Willi syndrome, the duplications appear to be mediated by unequal homologous recombination involving low copy repeats (LCR that are found clustered in the region. Five recurrent breakpoints have been described in most cases of segmental aneuploidy of chromosome 15q11-q13 and previous studies have shown that most idic(15 chromosomes arise through BP3:BP3 or BP4:BP5 recombination events. Results Here we describe four duplication chromosomes that show evidence of atypical recombination events that involve regions outside the common breakpoints. Additionally, in one patient with a mosaic complex der(15, we examined homologous pairing of chromosome 15q11-q13 alleles by FISH in a region of frontal cortex, which identified mosaicism in this tissue and also demonstrated pairing of the signals from the der(15 and the normal homologues. Conclusion Involvement of atypical BP in the generation of idic(15 chromosomes can lead to considerable structural heterogeneity.

  10. Mesiodens--diagnosis and management of a common supernumerary tooth.

    Science.gov (United States)

    Russell, Kathleen A; Folwarczna, Magdalena A

    2003-06-01

    Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Given this high frequency, the general dentist should be knowledgeable about the signs and symptoms of mesiodentes and appropriate treatment. The cause of mesiodentes is not fully understood, although proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance. It is therefore important for the clinician to diagnose a mesiodens early in development to allow for optimal yet minimal treatment. Treatment options may include surgical extraction of the mesiodens. If the permanent teeth do not erupt in a reasonable period after the extraction, surgical exposure and orthodontic treatment may be required to ensure eruption and proper alignment of the teeth. In some instances, fixed orthodontic therapy is also required to create sufficient arch space before eruption and alignment of the incisor(s). Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications. This paper outlines the causes and modes of presentation of mesiodentes, and presents guidelines for diagnosis and management of nonsyndromic mesiodentes.

  11. Mirror imaging of impacted and supernumerary teeth in dizygotic twins: A case report.

    Science.gov (United States)

    Cassetta, Michele; Altieri, Federica; Giordano, Alessandra

    2015-02-01

    Mesiodens is the most common type of supernumerary tooth found in the premaxilla. It might be discovered by the clinical examination by chance on a radiograph or as the cause of an unerupted maxillary central incisor. The genetic transmission of supernumerary and impacted teeth is poorly understood. Mirror imaging in twins has been reported frequently in relation to several unilateral dental anomalies including mesiodens. This phenomenon is the appearance of an asymmetrical feature or anomaly occurring on the right side of one twin but on the left side of the other twin. The event of mesiodens mirror imaging in monozygotic twins has been described in literature. This is the first reported case of mesiodens mirror images in dizygotic twins. The de-scribed mesiodens caused the eruption failure of maxillary permanent incisors. The super-numerary teeth were removed to facilitate the spontaneous eruption of the impacted perma-nent maxillary incisors. Studies related to supernumerary teeth can be useful to clinicians in the early diagnosis of this anomaly. Clinical and radiographic examinations provide a correct therapeutic approach. Key words:Supernumerary teeth, twins, dental development.

  12. Phantom breast syndrome

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    Ramesh

    2009-01-01

    Full Text Available Phantom breast syndrome is a type of condition in which patients have a sensation of residual breast tissue and can include both non-painful sensations as well as phantom breast pain. The incidence varies in different studies, ranging from approximately 30% to as high as 80% of patients after mastectomy. It seriously affects quality of life through the combined impact of physical disability and emotional distress. The breast cancer incidence rate in India as well as Western countries has risen in recent years while survival rates have improved; this has effectively increased the number of women for whom post-treatment quality of life is important. In this context, chronic pain following treatment for breast cancer surgery is a significantly under-recognized and under-treated problem. Various types of chronic neuropathic pain may arise following breast cancer surgery due to surgical trauma. The cause of these syndromes is damage to various nerves during surgery. There are a number of assumed factors causing or perpetuating persistent neuropathic pain after breast cancer surgery. Most well-established risk factors for developing phantom breast pain and other related neuropathic pain syndromes are severe acute postoperative pain and greater postoperative use of analgesics. Based upon current evidence, the goals of prophylactic strategies could first target optimal peri-operative pain control and minimizing damage to nerves during surgery. There is some evidence that chronic pain and sensory abnormalities do decrease over time. The main group of oral medications studied includes anti-depressants, anticonvulsants, opioids, N-methyl-D-asparate receptor antagonists, mexilitine, topical lidocaine, cannabinoids, topical capsaicin and glysine antagonists. Neuromodulation techniques such as motor cortex stimulation, spinal cord stimulation, and intrathecal drug therapies have been used to treat various neuropathic pain syndromes.

  13. Phantom stars and topology change

    CERN Document Server

    DeBenedictis, Andrew; Lobo, Francisco S N

    2008-01-01

    In this work, we consider time-dependent dark energy star models, with an evolving parameter $\\omega$ crossing the phantom divide, $\\omega=-1$. Once in the phantom regime, the null energy condition is violated, which physically implies that the negative radial pressure exceeds the energy density. Therefore, an enormous negative pressure in the center may, in principle, imply a topology change, consequently opening up a tunnel and converting the dark energy star into a wormhole. The criteria for this topology change are discussed, in particular, we consider the Morse Index analysis and a Casimir energy approach involving quasi-local energy difference calculations that may reflect or measure the occurrence of a topology change. We denote these exotic geometries consisting of dark energy stars (in the phantom regime) and phantom wormholes as phantom stars. The final product of this topological change, namely, phantom wormholes, have far-reaching physical and cosmological implications, as in addition to being use...

  14. Reliability of phantom pain relief in neurorehabilitation using a multimodal virtual reality system.

    Science.gov (United States)

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

    2015-01-01

    The objective of this study is to demonstrate the reliability of relief from phantom limb pain in neurore-habilitation using a multimodal virtual reality system. We have developed a virtual reality rehabilitation system with multimodal sensory feedback and applied it to six patients with brachial plexus avulsion or arm amputation. In an experiment, patients executed a reaching task using a virtual phantom limb displayed in a three-dimensional computer graphic environment manipulated by their real intact limb. The intensity of the phantom limb pain was evaluated through a short-form McGill pain questionnaire. The experiments were conducted twice on different days at more than four-week intervals for each patient. The reliability of our task's ability to relieve pain was demonstrated by the test-retest method, which checks the degree of the relative similarity between the pain reduction rates in two experiments using Fisher's intraclass correlation coefficient (ICC). The ICC was 0.737, indicating sufficient reproducibility of our task. The average of the reduction rates across participants was 50.2%, and it was significantly different from 0 (p virtual reality system reduces the phantom limb pain with sufficient reliability.

  15. Multiple Supernumerary Teeth in a Non-Syndromic Patient: A Case Report

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    Majid Eshgh Pour

    2013-01-01

    Full Text Available Introduction: Multiple supernumerary teeth are a rare phenomenon. It occurs more often in patients with syndromes such as Gardner's syndrome, cleidocranial dysplasia and so on. This phenomenon in absence of such syndromes is rare. The purpose of this report was to introduce a case of non-syndromic multiple supernumerary impacted teeth.Case Report: A 29-year-old woman with no skeletal, metabolic, systemic and mental disorder was referred to oral and maxillofacial department of Mashhad dental school. In clinical evaluation, seven Permanent teeth were missing. In radiographic evaluation, there were a total of 15 impacted teeth which 7 of them were supernumerary.Conclusion: Missing or Excess of one or more teeth usually leads to occlusal and functional problems. In these cases, a complete clinical and radiographic examination accompanieal by a precise history should be performed to plan a suitable surgical-orthodontic-prosthetic treatment.

  16. Sequential supernumerary teeth development in a non-syndromic patient; report of a rare case.

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    Mohammad Jafarian

    2013-12-01

    Full Text Available Isolated impacted supernumerary teeth are quite rare, but they can be seen associated with several syndromes such as cleidocranial dysostosis or Gardner's syndrome. This article aims to discuss a case of sequential formation of supernumerary teeth with no other associated disease or syndrome. A 17-year-old Iranian male with 8 impacted supernumerary teeth was referred to the department of pediatric dental clinic at Shahid Beheshti Medical University in Tehran with a history of several impacted unerupted teeth. Repeated and periodical clinical and radiographic examinations revealed newly formed teeth buds in unusual dental ages. All extra teeth were associated with generalized enamel hypoplasia to some degree on their relative permanent adjacent teeth. The patient did not have any record of a systemic disease or any syndromic condition to relate his dental problem to. This rare condition involved repeated and continued formation of extra teeth out of the normal numbers and dental age evident in serial radiographs.

  17. Use of a Piezosurgery Technique to Remove a Deeply Impacted Supernumerary Tooth in the Anterior Maxilla

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    Shintaro Sukegawa

    2015-01-01

    Full Text Available Deeply impacted supernumerary teeth in the anterior maxillary cannot be generally removed by the conventional labial or palatal surgical approach because of the risk of damaging the surrounding soft tissues and the possibility of injuring the roots of adjacent permanent teeth. In piezosurgery, bony tissues are selectively cut, thereby avoiding the soft tissue damage caused by rotary cutting instruments. We report the case of a 15-year-old Japanese boy from whom a deeply impacted supernumerary tooth in the anterior maxillary was safely removed through the floor of the nasal cavity. The surgical extraction was performed without damaging the nasal mucosa or adjacent structures such as the roots of the adjacent permanent teeth. Considering that piezosurgery limits the extent of surgical invasion, this technique can be practiced as a minimally invasive and safe surgical procedure for treating suitably selected cases with a deeply impacted supernumerary tooth.

  18. Multi-Modality Phantom Development

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    Huber, Jennifer S.; Peng, Qiyu; Moses, William W.

    2009-03-20

    Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe both our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.

  19. Management of Delayed Eruption of Permanent Maxillary Incisor associated with the Presence of Supernumerary Teeth: A Case Report

    Science.gov (United States)

    Nagpal, Rajni; Singh, Mousumi; Chaudhary, Seema

    2011-01-01

    A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. Clinically, supernumerary teeth are able to cause different local disorders. It is important for the dentist to be aware of the clinical complications of supernumerary teeth, the most common being the delayed eruption of permanent teeth. Early diagnosis and management of supernumerary teeth is important to prevent the need for more complex surgical and orthodontic treatment. This case report highlights the problem of delayed eruption of permanent maxillary left central incisor in a 9-year-old boy due to two supernumerary teeth, one tuberculate type and other impacted inverted mesiodens. PMID:27678238

  20. The dynamics of supernumerary tooth development are differentially regulated by Sprouty genes.

    Science.gov (United States)

    Lagronova-Churava, Svatava; Spoutil, Frantisek; Vojtechova, Simona; Lesot, Herve; Peterka, Miroslav; Klein, Ophir D; Peterkova, Renata

    2013-07-01

    In mice, a toothless diastema separates the single incisor from the three molars in each dental quadrant. In the prospective diastema of the embryo, small rudimentary buds are found that are presumed to be rudiments of suppressed teeth. A supernumerary tooth occurs in the diastema of adult mice carrying mutations in either Spry2 or Spry4. In the case of Spry2 mutants, the origin of the supernumerary tooth involves the revitalization of a rudimentary tooth bud (called R2), whereas its origin in the Spry4 mutants is not known. In addition to R2, another rudimentary primordium (called MS) arises more anteriorly in the prospective diastema. We investigated the participation of both rudiments (MS and R2) in supernumerary tooth development in Spry2 and Spry4 mutants by comparing morphogenesis, proliferation, apoptosis, size and Shh expression in the dental epithelium of MS and R2 rudiments. Increased proliferation and decreased apoptosis were found in MS and R2 at embryonic day (ED) 12.5 and 13.5 in Spry2(-/-) embryos. Apoptosis was also decreased in both rudiments in Spry4(-/-) embryos, but the proliferation was lower (similar to WT mice), and supernumerary tooth development was accelerated, exhibiting a cap stage by ED13.5. Compared to Spry2(-/-) mice, a high number of Spry4(-/-) supernumerary tooth primordia degenerated after ED13.5, resulting in a low percentage of supernumerary teeth in adults. We propose that Sprouty genes were implicated during evolution in reduction of the cheek teeth in Muridae, and their deletion can reveal ancestral stages of murine dental evolution. Copyright © 2013 Wiley Periodicals, Inc.

  1. An epidemiological study on supernumerary teeth: a survey on 5,000 people.

    Science.gov (United States)

    Kumar, Dara Kalyan; Gopal, K Saraswathy

    2013-07-01

    The formation of dental tissues is a highly delicate and complex phenomenon. Any alteration in this process leads to various dental anomalies which affect the tooth number, size, shape and structure. Supernumerary teeth are one such anomaly which affects the tooth number. Supernumerary teeth can give rise to various complications and pathologies or they may have a familial / syndromic association. They may occur along with other dental anomalies. Thus, such teeth have a definite clinical significance. The aim of the following study was to know the prevalence of the supernumerary teeth and the distribution of the cases according to the age, sex, jaw, region, eruption status, and the position. A total of 5000 patients were examined for a period of 1 year's duration and they were divided into different groups. Group I consisted of individuals who were aged between 5-20 years, Group II consisted of individuals who were aged between 21-40 years, and Group III consisted of individuals who were aged 41 years and above. The dental examination was conducted by using a mouth mirror and a probe, to determine the presence of supernumerary teeth. All the cases with supernumerary teeth were further observed and the details were recorded in a prepared porforma. These cases were also subjected to general physical examinations (to rule out any syndromes) and radiographic examinations. Photographs were also made. Although supernumerary teeth is an unusual anomaly, it is not as rare as was previously reported. The identification of this anomaly could provide a hint towards the possibility of complications, pathologies, other dental anomalies, syndromes and a familial association.

  2. Endodontic management of a supernumerary tooth fused to the maxillary permanent lateral Incisor

    Directory of Open Access Journals (Sweden)

    Avinash A Patil

    2014-01-01

    Full Text Available The aim of this case report is to present the endodontic management of a supernumerary tooth fused to the maxillary left lateral incisor. Such anomalies pose a challenge even to the most experienced clinician in treating these teeth. This report described a case of 21-year-old male patient with a classic case of complete fusion of maxillary left lateral incisor and a supernumerary tooth. A modified access preparation was made and two separate root canal orifices were identified. Both root canal systems were prepared separately and obturated efficiently until accepted lengths. This reported case highlights the importance of clinical and radiographic correlation in arriving to a definitive diagnosis.

  3. Unusual Case of a Talon Cusp on a Supernumerary Tooth in Association with a Mesiodens

    Directory of Open Access Journals (Sweden)

    Prashant Babaji

    2010-06-01

    Full Text Available Talon cusp is an accessory cusp similar to a projection, extending from the cingulum or cemento-enamel junction to the incisal edge. It occurs on labial or palatal surfaces of primary or permanent anterior teeth in both arches. This accessory cusp can occur as an isolated entity or in association with other dental anomalies. Occurrence of a talon cusp on supernumerary teeth is rare and uncommon. This paper reports an unusual case of a talon cusp on a supernumerary tooth in association with mesiodens.

  4. Hypohyperdontia: Agenesis of three third molars and mandibular centrals associated with midline supernumerary tooth in mandible

    Directory of Open Access Journals (Sweden)

    Sivakumar Nuvvula

    2010-01-01

    Full Text Available Agenesis of teeth in a patient who also presents with a supernumerary tooth is one of the rare numerical anomalies in human dentition. Agenesis of third molars was shown to be associated with other missing permanent teeth. A review of literature on hypodontia including third molar agenesis, hyperdontia and a concomitant presence of these two conditions which is termed as hypohyperdontia is presented along with a case showing agenesis of three third molars, both mandibular central incisors and a midline supernumerary tooth.

  5. Dentigerous cyst associated with ectopic canine and a supernumerary tooth: a rare occurrence.

    Science.gov (United States)

    Ramakrishna, Ashwini; Lambade, Pravin

    2013-07-01

    Amongst the cysts of the jaw dentigerous cyst (DC) is one of the most prevalent types of odontogenic cysts, which is associated with the crown of an unerupted or developing tooth. DC is more commonly seen with mandibular third molar and maxillary canine and rarely other teeth are involved. These cysts seldom associate with supernumerary teeth. The purpose of this article is to describe a case of large dentigerous cyst associated with supernumerary teeth and an ectopic canine, which is a rare presentation along with its management.

  6. Diagnosis and Management of Supernumerary (Mesiodens: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    G. Meighani

    2010-03-01

    Full Text Available Supernumerary tooth is one of the developmental problems in children. Mesiodens is a supernumerary tooth present in the midline between the two central incisors. It usually results in oral problems such as malocclusion, food impaction, poor aesthetics, and cyst formation. The prevalence of mesiodens varies between 0.09% and 2.05% in different studies.This paper reviews current literature on etiology, prevalence, diagnosis, and management of this problem. Accordingly, early diagnosis and treatment is suggested to preventorthodontic and pathologic complications.

  7. Unusual case of a talon cusp on a supernumerary tooth in association with a mesiodens.

    Science.gov (United States)

    Babaji, Prashant; Sanadi, Firoza; Melkundi, Mahesh

    2010-01-01

    Talon cusp is an accessory cusp similar to a projection, extending from the cingulum or cemento-enamel junction to the incisal edge. It occurs on labial or palatal surfaces of primary or permanent anterior teeth in both arches. This accessory cusp can occur as an isolated entity or in association with other dental anomalies. Occurrence of a talon cusp on supernu-merary teeth is rare and uncommon. This paper reports an unusual case of a talon cusp on a supernumerary tooth in association with mesiodens.

  8. [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.

  9. The Phantom of Liberty

    DEFF Research Database (Denmark)

    One of the few things we have in common in contemporary society is the future of our children. But it seems that even the “we” of childhood, of learning and free play, has turned into a common ground for instrumentalization and competition. Today, the pedagogical paradox—Kant’s meditation...... on the paradox that the subject’s predisposition for freedom must be learned—is increasingly lost in governmental obsession about the efficiency of education and schooling. From another perspective, artists are addressing questions of childhood, play, and pedagogy. What ideological and moral transformations......? These are some of the questions addressed by The Phantom of Liberty, which sets out to reestablish a social and aesthetic dialogue between visual art and psychology, philosophy, pedagogy, and critical journalism....

  10. Centromere activity in dicentric small supernumerary marker chromosomes.

    Science.gov (United States)

    Ewers, Elisabeth; Yoda, Kinya; Hamid, Ahmed B; Weise, Anja; Manvelyan, Marina; Liehr, Thomas

    2010-07-01

    Twenty-five dicentric small supernumerary marker chromosomes (sSMC) derived from #13/21, #14, #15, #18, and #22 were studied by immunohistochemistry for their centromeric activity. Centromere protein (CENP)-B was applied as marker for all centromeres and CENP-C to label the active ones. Three different 'predominant' activation patterns could be observed, i.e., centric fusion or either only one or all two centromeres were active. In one inherited case, the same activation pattern was found in mother and son. In acrocentric-derived sSMC, all three activation patterns could be present. In contrary, in chromosome 18-derived sSMC, only the fusion type was observed. In concordance with previous studies a certain centromeric plasticity was observed in up to 13% of the cells of an individual case. Surprisingly, the obtained data suggests a possible influence of the sSMC carrier's gender on the implementation of the predominant activation pattern; especially, only one active centromere was found more frequently in female than in male carriers. Also, it might be suggested that dicentric sSMC with one active centromere could be less stable than such with two active ones-centromeric plasticity might have an influence here, as well. Also, centromere activity in acrocentric-derived dicentrics could be influenced by heteromorphisms of the corresponding short arms. Finally, evidence is provided that the closer the centromeres of a dicentric are and if they are not fused, the more likely it was that both of them became active. In concordance and refinement with previous studies, a distance of 1.4 Mb up to about 13 Mb the two active centromere state was favored, while centromeric distance of over approximately 15 Mb lead to inactivation of one centromere. Overall, here, the first and largest ever undertaken study in dicentric sSMC is presented, providing evidence that the centromeric activation pattern is, and parental origin may be of interest for their biology. Influence of

  11. An alternative to traditional mirror therapy: illusory touch can reduce phantom pain when illusory movement does not.

    Science.gov (United States)

    Schmalzl, Laura; Ragnö, Christina; Ehrsson, H Henrik

    2013-10-01

    There is evidence that amputation leads to cortical reorganization, and it has been suggested that phantom pain might be related to a consequently emerging incongruence of motor intention, somatosensation and visual feedback. One therapeutic approach that has the potential to temporarily resolve this visuo-proprioceptive dissociation is mirror therapy, during which amputees typically move their intact limb while observing its reflection in a mirror, which in turn evokes the illusory perception of movement of their phantom limb. However, while the action of moving the phantom relieves pain for some patients, it can actually increase cramping sensations in others. In the current study we therefore implemented an alternative version of the mirror therapy involving a visuotactile illusion, to explore whether it might be effective with amputees for whom the action of moving the phantom increases phantom pain. We recruited six upper limb amputees who had been previously exposed to the classical mirror therapy with no or limited success, and exposed them to two differential experimental conditions involving visualization paired with either illusory movement or illusory touch of the phantom hand. While none of the participants benefitted from the movement condition, five participants showed a significant pain reduction during the stroking condition. Albeit preliminary, our results represent an encouraging finding of possible future clinical relevance, and indicate that the type of multisensory stimulation that most efficiently reduces phantom pain can vary in different sub-populations of amputees.

  12. Clinical management of a fused upper premolar with supernumerary tooth: a case report

    Directory of Open Access Journals (Sweden)

    Kyu-Min Cho

    2014-11-01

    Full Text Available n dentistry, the term 'fusion' is used to describe a developmental disorder of dental hard tissues. In the permanent dentition, fusion of a normal tooth and a supernumerary tooth usually involves the incisors or canines. However, a few cases of fusion involving premolars have also been reported to date. We present a rare case in which fusion of the maxillary left second premolar and a supernumerary tooth in a 13-year-old girl was diagnosed using cone beam computed tomography (CBCT, Alphard-3030, Asahi Roentgen Ind. Co., Ltd.. The tooth was bicuspidized after routine nonsurgical root canal treatment, and the separated teeth underwent appropriate restoration procedures. The second premolar and supernumerary tooth remained asymptomatic without any signs of inflammation after a follow-up period of 9 years. Identification of anatomical anomalies is important for treatment in cases involving fusion with supernumerary tooth, and therefore the microscopic examinations and CBCT are essential for the diagnosis. Fused teeth can be effectively managed by the comprehensive treatment which includes both endodontic and periodontal procedures.

  13. Lateral incisor agenesis, canine impaction and characteristics of supernumerary teeth in a South European male population

    NARCIS (Netherlands)

    Delli, Konstantina; Livas, Christos; Bornstein, Michael M

    2013-01-01

    OBJECTIVE: To assess the prevalence of lateral incisor agenesis impacted canines and supernumerary teeth in a young adult male population. MATERIALS AND METHODS: The panoramic radiographs of 1745 military students (mean age: 18.6 ± 0.52 years) who attended the Center of Aviation Medicine of the Arme

  14. Multiple crown size variables of the upper incisors in patients with supernumerary teeth compared with controls

    NARCIS (Netherlands)

    Khalaf, K.; Smith, R. N.; Elcock, C.; Brook, A. H.

    2009-01-01

    Aims: As part of ongoing studies of the aetiology of dental anomalies the aims of this study were to identify multiple components of tooth size of the upper permanent incisors in 34 patients with supernumerary teeth and to compare them with those in a control group to determine whether the presence

  15. Lateral incisor agenesis, canine impaction and characteristics of supernumerary teeth in a South European male population

    NARCIS (Netherlands)

    Delli, Konstantina; Livas, Christos; Bornstein, Michael M

    2013-01-01

    OBJECTIVE: To assess the prevalence of lateral incisor agenesis impacted canines and supernumerary teeth in a young adult male population. MATERIALS AND METHODS: The panoramic radiographs of 1745 military students (mean age: 18.6 ± 0.52 years) who attended the Center of Aviation Medicine of the Arme

  16. Multidisciplinary management of impacted central incisors due to supernumerary teeth and an associated dentigerous cyst

    Directory of Open Access Journals (Sweden)

    Ritesh R Kalaskar

    2011-01-01

    Full Text Available Supernumerary teeth are the most common developmental dental anomaly resulting from hyperactivity of dental lamina, dichotomy, environmental factor, or polygenetic process of atavism. Supernumerary teeth present classical oral complication such as impaction of adjacent teeth, crowding, diastema formation, rotation, displacement of teeth, and occlusal interference. A dentigerous cyst associated with anterior supernumerary teeth (mesiodens is rare and accounts for 5% of all dentigerous cysts. The present case reports describe the successful management of the impacted permanent maxillary central incisor positioned high in the vestibule. A combination of surgical and orthodontic techniques was employed to improve treatment outcome with greater hard and soft tissue preservation and to prevent psychological problems. In the surgical phase, supernumerary teeth and dentigerous cyst were removed. Subsequently traction was employed by bonding bracket on the labial surface using closed and open eruption techniques. Successively, fixed orthodontic treatment was started to align permanent maxillary central incisors in an occlusal plane. Thus, combination of surgical and orthodontic method can be the treatment of choice over surgical extraction, implant placement, and surgical repositioning.

  17. [Diagnosis and treatment of supernumerary teeth in the premaxillary region: a literature review].

    Science.gov (United States)

    Ratson, T

    2013-01-01

    Supernumerary teeth are more frequently located in the premaxillary region. Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Supernumerary teeth are frequently diagnosed in a random radiograph, or after clinical symptoms appear. The majority of the complications consist of delayed or ectopic eruption of the permanent incisors. It is important for the clinician to be aware of the phenomenon and its implications, in order to diagnose it as early as possible. Extraction of the supernumerary teeth in the late mixed dentition, will minimize the chances of damaging the adjacent permanent teeth, but will reduce the possibility of spontaneous eruption of an impacted permanent incisor. Extraction in the early mixed dentition can expedite the eruption of the permanent incisor, although it may involve sedation or general anesthesia, due to lack of cooperation in the young patient. Because to the risk of uneruption of the permanent impacted incisor, exposure of the teeth and bonding a ligature or bracket at the same procedure, and providing a possibility for the dentist to make the incisor erupt after the first operation, should the incisor not erupt spontaneously. Treating these cases require the cooperation of pediatric dentist, orthodontic and dental surgeon, and sometimes the involvement of an anesthesiologist.

  18. Nonsyndromic Bilateral Multiple Impacted Supernumerary Mandibular Third Molars: A Rare and Unusual Case Report

    Directory of Open Access Journals (Sweden)

    G. Siva Prasad Reddy

    2013-01-01

    Full Text Available A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.

  19. Hemangioendothelioma of bone in a patient with a constitutional supernumerary marker

    DEFF Research Database (Denmark)

    Rogatto, S R; Rainho, C A; Zhang, Z M

    1999-01-01

    A 13-year old girl was diagnosed as having a bone hemangioendothelioma. Cytogenetic studies identified the presence of a small supernumerary marker chromosome in this patient. Classical cytogenetic methods using G-, C-, Ag-NOR-banding were supplemented by spectral karyotyping (SKY) and fluorescen...

  20. Multidisciplinary management of impacted central incisors due to supernumerary teeth and an associated dentigerous cyst

    Science.gov (United States)

    Kalaskar, Ritesh R.; Kalaskar, Ashita R.

    2011-01-01

    Supernumerary teeth are the most common developmental dental anomaly resulting from hyperactivity of dental lamina, dichotomy, environmental factor, or polygenetic process of atavism. Supernumerary teeth present classical oral complication such as impaction of adjacent teeth, crowding, diastema formation, rotation, displacement of teeth, and occlusal interference. A dentigerous cyst associated with anterior supernumerary teeth (mesiodens) is rare and accounts for 5% of all dentigerous cysts. The present case reports describe the successful management of the impacted permanent maxillary central incisor positioned high in the vestibule. A combination of surgical and orthodontic techniques was employed to improve treatment outcome with greater hard and soft tissue preservation and to prevent psychological problems. In the surgical phase, supernumerary teeth and dentigerous cyst were removed. Subsequently traction was employed by bonding bracket on the labial surface using closed and open eruption techniques. Successively, fixed orthodontic treatment was started to align permanent maxillary central incisors in an occlusal plane. Thus, combination of surgical and orthodontic method can be the treatment of choice over surgical extraction, implant placement, and surgical repositioning. PMID:22114457

  1. Genome-wide genetic dissection of supernumerary spikelet and related traits in common wheat

    Science.gov (United States)

    Branched spike or supernumerary spikelet (SS) is a naturally occurring variant in wheat and holds great potential for increasing the number of grains per spike, and ultimately, increasing wheat yield. However, detailed knowledge of the molecular basis of spike branching in common wheat is lacking. I...

  2. Amputation, phantom pain and subjective well-being : a qualitative study

    NARCIS (Netherlands)

    Bosmans, J.C.; Suurmeijer, T.P.B.M.; Hulsink, M.; van der Schans, C.P.; Geertzen, J.H.B.; Dijkstra, P.U.

    2007-01-01

    The purpose of this qualitative study was to explore the impact of an amputation and of phantom pain on the subjective well-being of amputees. Sixteen lower-limb amputees were interviewed. A semi-structured interview and two Visual Analogue Scales were used. To interpret the results, a new socio-med

  3. The genome of Nectria haematococca: contribution of supernumerary chromosomes to gene expansion

    Energy Technology Data Exchange (ETDEWEB)

    Coleman, J.J.; Rounsley, S.D.; Rodriguez-Carres, M.; Kuo, A.; Wasmann, C.c.; Grimwood, J.; Schmutz, J.; Taga, M.; White, G.J.; Zhuo, S.; Schwartz, D.C.; Freitag, M.; Ma, L.-J.; Danchin, E.G.J.; Henrissat, B.; Cutinho, P.M.; Nelson, D.R.; Straney, D.; Napoli, C.A.; Baker, B.M.; Gribskov, M.; Rep, M.; Kroken, S.; Molnar, I.; Rensing, C.; Kennell, J.C.; Zamora, J.; Farman, M.L.; Selker, E.U.; Salamov, A.; Shapiro, H.; Pangilinan, J.; Lindquist, E.; Lamers, C.; Grigoriev, I.V.; Geiser, D.M.; Covert, S.F.; Temporini, S.; VanEtten, H.D.

    2009-04-20

    The ascomycetous fungus Nectria haematococca, (asexual name Fusarium solani), is a member of a group of .50 species known as the"Fusarium solani species complex". Members of this complex have diverse biological properties including the ability to cause disease on .100 genera of plants and opportunistic infections in humans. The current research analyzed the most extensively studied member of this complex, N. haematococca mating population VI (MPVI). Several genes controlling the ability of individual isolates of this species to colonize specific habitats are located on supernumerary chromosomes. Optical mapping revealed that the sequenced isolate has 17 chromosomes ranging from 530 kb to 6.52 Mb and that the physical size of the genome, 54.43 Mb, and the number of predicted genes, 15,707, are among the largest reported for ascomycetes. Two classes of genes have contributed to gene expansion: specific genes that are not found in other fungi including its closest sequenced relative, Fusarium graminearum; and genes that commonly occur as single copies in other fungi but are present as multiple copies in N. haematococca MPVI. Some of these additional genes appear to have resulted from gene duplication events, while others may have been acquired through horizontal gene transfer. The supernumerary nature of three chromosomes, 14, 15, and 17, was confirmed by their absence in pulsed field gel electrophoresis experiments of some isolates and by demonstrating that these isolates lacked chromosome-specific sequences found on the ends of these chromosomes. These supernumerary chromosomes contain more repeat sequences, are enriched in unique and duplicated genes, and have a lower G+C content in comparison to the other chromosomes. Although the origin(s) of the extra genes and the supernumerary chromosomes is not known, the gene expansion and its large genome size are consistent with this species' diverse range of habitats. Furthermore, the presence of unique genes on

  4. The genome of Nectria haematococca: contribution of supernumerary chromosomes to gene expansion.

    Directory of Open Access Journals (Sweden)

    Jeffrey J Coleman

    2009-08-01

    Full Text Available The ascomycetous fungus Nectria haematococca, (asexual name Fusarium solani, is a member of a group of >50 species known as the "Fusarium solani species complex". Members of this complex have diverse biological properties including the ability to cause disease on >100 genera of plants and opportunistic infections in humans. The current research analyzed the most extensively studied member of this complex, N. haematococca mating population VI (MPVI. Several genes controlling the ability of individual isolates of this species to colonize specific habitats are located on supernumerary chromosomes. Optical mapping revealed that the sequenced isolate has 17 chromosomes ranging from 530 kb to 6.52 Mb and that the physical size of the genome, 54.43 Mb, and the number of predicted genes, 15,707, are among the largest reported for ascomycetes. Two classes of genes have contributed to gene expansion: specific genes that are not found in other fungi including its closest sequenced relative, Fusarium graminearum; and genes that commonly occur as single copies in other fungi but are present as multiple copies in N. haematococca MPVI. Some of these additional genes appear to have resulted from gene duplication events, while others may have been acquired through horizontal gene transfer. The supernumerary nature of three chromosomes, 14, 15, and 17, was confirmed by their absence in pulsed field gel electrophoresis experiments of some isolates and by demonstrating that these isolates lacked chromosome-specific sequences found on the ends of these chromosomes. These supernumerary chromosomes contain more repeat sequences, are enriched in unique and duplicated genes, and have a lower G+C content in comparison to the other chromosomes. Although the origin(s of the extra genes and the supernumerary chromosomes is not known, the gene expansion and its large genome size are consistent with this species' diverse range of habitats. Furthermore, the presence of unique

  5. Atypical Odontalgia (Phantom Tooth Pain)

    Science.gov (United States)

    ... Odontalgia Atypical odontalgia, also known as atypical facial pain, phantom tooth pain, or neuropathic orofacial pain, is characterized by chronic pain in a tooth or teeth, or in a site where teeth ...

  6. Organosilicon phantom for photoacoustic imaging.

    Science.gov (United States)

    Avigo, Cinzia; Di Lascio, Nicole; Armanetti, Paolo; Kusmic, Claudia; Cavigli, Lucia; Ratto, Fulvio; Meucci, Sandro; Masciullo, Cecilia; Cecchini, Marco; Pini, Roberto; Faita, Francesco; Menichetti, Luca

    2015-04-01

    Photoacoustic imaging is an emerging technique. Although commercially available photoacoustic imaging systems currently exist, the technology is still in its infancy. Therefore, the design of stable phantoms is essential to achieve semiquantitative evaluation of the performance of a photoacoustic system and can help optimize the properties of contrast agents. We designed and developed a polydimethylsiloxane (PDMS) phantom with exceptionally fine geometry; the phantom was tested using photoacoustic experiments loaded with the standard indocyanine green dye and compared to an agar phantom pattern through polyethylene glycol-gold nanorods. The linearity of the photoacoustic signal with the nanoparticle number was assessed. The signal-tonoiseratio and contrast were employed as image quality parameters, and enhancements of up to 50 and up to 300%, respectively, were measured with the PDMS phantom with respect to the agar one. A tissue-mimicking (TM)-PDMS was prepared by adding TiO2 and India ink; photoacoustic tests were performed in order to compare the signal generated by the TM-PDMS and the biological tissue. The PDMS phantom can become a particularly promising tool in the field of photoacoustics for the evaluation of the performance of a PA system and as a model of the structure of vascularized soft tissues.

  7. Surgical management of impacted incisors in associate with supernumerary teeth: A combine case report of spontaneous eruption and orthodontic extrusion

    Directory of Open Access Journals (Sweden)

    D Das

    2012-01-01

    Full Text Available Maxillary permanent incisors impaction is not a frequent case in dental practice, but its treatment is challenging because of its importance to facial esthetics. Supernumerary teeth are the main cause of impaction of upper incisors. Supernumerary teeth when present can cause both esthetic and pathologic problems. Early detection of such teeth is most important if complications are to be avoided. In this reported case, the orthopantamogram of a 9-year-old boy revealed two impacted supernumerary teeth in the maxillary anterior region, which was interfering with the eruption of the permanent central incisors. The impacted supernumerary teeth were surgically removed, 11 was repositioned in the arch as it was situated very high in the arch, close to the nasal floor. Twenty-one erupted spontaneously but orthodontic force was applied over 11 to bring it into the occlusion and alignment was achieved with 0.014 mm NiTi wire.

  8. The effect of tail skin on the morphology and morphogenesis of limb regenerates in the red-backed salamander, Plethodon cinereus.

    Science.gov (United States)

    Dinsmore, C E

    1982-10-01

    Tail skin cuffs have been grafted to the upper forelimb of red-backed salamanders in either normal or 180 degrees-rotated dorsoventral orientation. Subsequent amputation through the graft region resulted in arrested regeneration, distally deficient or typical four-digit regenerates. Distribution was not substantially influenced by graft orientation nor were there any supernumerary limbs induced by the axially dislocated tail skin on the limb stumps. Furthermore, regenerates bore no indication of tail-like structures other than large granular skin glands proximally. These data indicate that, unlike limb skin, tail skin is not morphogenetically active in the epimorphic process of limb regeneration. In addition, the species used in this study is a fin-less, round-tailed salamander. It is therefore suggested that the previously reported morphogenetic effects of tail skin on limb regeneration may be related to the presence of tail fins on the species studied.

  9. "Imprisoned" in pain: analyzing personal experiences of phantom pain.

    Science.gov (United States)

    Nortvedt, Finn; Engelsrud, Gunn

    2014-11-01

    This article explores the phenomenon of "phantom pain." The analysis is based on personal experiences elicited from individuals who have lost a limb or live with a paralyzed body part. Our study reveals that the ways in which these individuals express their pain experience is an integral aspect of that experience. The material consists of interviews undertaken with men who are living with phantom pain resulting from a traumatic injury. The phenomenological analysis is inspired by Zahavi (J Conscious Stud 8(5-7):151-167, 2001) and Merleau-Ponty (Phenomenology of perception. Routledge and Kegan Paul, London, 1962/2000). On a descriptive level the metaphors these patients invoke to describe their condition reveal immense suffering, such as a feeling of being invaded by insects or of their skin being scorched and stripped from their body. Such metaphors express a dimension of experience concerning the self that is in pain and others whom the sufferer relates to through this pain, as well as the agony that this pain inflicts in the world of lived experience. This pain has had a profound impact on their lives and altered their relationship with self (body), others and the world. Their phantom pain has become a reminder of their formerly intact and functioning body; they describe the contrast between their past and present body as an ambiguous and disturbing experience. We conclude that these sensitive and personalized experiences of phantom pain illuminates how acts of expression--spoken pain--constitute a fundamental dimension of a first-person perspective which contribute to the field of knowledge about "phantom pain".

  10. Pallister-Killian syndrome caused by mosaicism for a supernumerary ring chromosome 12p.

    Science.gov (United States)

    Yeung, Alison; Francis, David; Giouzeppos, Olivia; Amor, David J

    2009-03-01

    Pallister-Killian syndrome (PKS) is a rare but distinctive chromosomal syndrome distinguished by severe intellectual impairment, characteristic facial features, and variable structural anomalies. The characteristic cytogenetic abnormality in PKS is a supernumerary isochromosome 12p that confers mosaic tetrasomy. We describe a female child with PKS in whom tetrasomy 12p resulted from a supernumerary ring chromosome containing two copies of chromosome 12cen --> p13, a novel cytogenetic finding. The ring chromosome exhibited tissue-limited mosaicism, being absent in blood but detected in 38% of buccal mucosa cells and 41% of skin fibroblasts. Our patient demonstrated the typical dysmorphic characteristics of PKS, but her development was relatively advanced in comparison to children with isochromosome PKS. Her milder developmental phenotype may be attributable to differences in the mosaic distribution or the genomic content of the ring chromosome compared to mosaic isochromosome 12p.

  11. Expansion of the Rib Head: A Novel Computed Tomographic Feature of Supernumerary Intrathoracic Ribs.

    Science.gov (United States)

    Kabakus, Ismail Mikdat; Atceken, Zeynep; Ariyurek, Orhan Macit

    2017-02-01

    Intrathoracic ribs are very rare congenital anomalies. Approximately 50 cases have been reported in the literature till date. They are usually present on the right side, between the third and eighth ribs without sex predominance. They may originate from a vertebral body or the proximal or distal part of a rib. In most cases, they are asymptomatic, but they may be associated with developmental abnormalities of ribs and vertebrae. The diagnosis is important to prevent further investigation or intervention. Here we present two rare cases with supernumerary intrathoracic rib and describe a novel sign, namely expansion of the rib head. To the best of our knowledge, this is the shortest supernumerary intrathoracic rib, reported in the literature, on the left side originating from the head of the second rib, which could have been misdiagnosed as osteochondroma due to its atypical features.

  12. Supernumerary Nipples, Congenital Scoliosis, Spina Bifida, Diastematomyelia, and Crossed Renal Ectopia in a child

    Directory of Open Access Journals (Sweden)

    Kiran Panthee

    2016-11-01

    Full Text Available Introduction: Supernumerary nipples are common anomalies which may be associated with several systemic disorders, particularly urinary tract abnormalities.   Case report: Here we report a case of a 4½ year old male presenting to the pediatric out patient clinic with fever for three days and recurrent sinopulmonary infections. The child had supernumerary nipples over the right side with deformed thoracic cage, congenital scoliosis, diastematomyelia, crossed renal ectopia, and spina bifida. All the conditions present together did not match any syndrome reported till date.   Conclusion: This was a rare syndrome and did not match fully with any known syndromes till date. This case warranted further investigation for its definite diagnosis but we do not have resources to that extent.

  13. Recurrent epistaxis caused by an intranasal supernumerary tooth in a young adult

    OpenAIRE

    Al Dhafeeri, Hamed O.; Kavarodi, Abdulmajid; Shaikh, Khalil Al; Bukhari, Ahmed; Hussain, Omair Al; Baramawy, Ahmed El

    2014-01-01

    Patient: Male, 27 Final Diagnosis: Recurrent epistaxis Symptoms: Nasal bleeding Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology Objective: Congenital defects/diseases Background: Recurrent epistaxis is a common disorder among children and young adults. We report an unusual cause, intranasal supernumerary tooth causing friction with Little’s area of the nasal septum. Case Report: A 22-year-old male presented with recurrent, mild, unilateral left-sided epistaxis once t...

  14. Bilateral fusion of mandibular second molars with supernumerary teeth: case report

    Directory of Open Access Journals (Sweden)

    Nunes Eduardo

    2002-01-01

    Full Text Available Fusion is a developmental anomaly characterized by the union of two adjacent teeth. In this article we report a rare case of bilateral fusion of permanent mandibular second molars with supernumerary teeth. The rarity with which this entity appears, along with its complex characteristics, often make it difficult to treat. The endodontic management of one tooth is described, as well as the successful treatment of a periradicular lesion.

  15. Mosaic small supernumerary marker chromosome 1 at amniocentesis: prenatal diagnosis, molecular genetic analysis and literature review.

    Science.gov (United States)

    Chen, Chih-Ping; Chen, Ming; Su, Yi-Ning; Huang, Jian-Pei; Chern, Schu-Rern; Wu, Peih-Shan; Su, Jun-Wei; Chang, Shun-Ping; Chen, Yu-Ting; Lee, Chen-Chi; Chen, Li-Feng; Pan, Chen-Wen; Wang, Wayseen

    2013-10-15

    We present prenatal diagnosis and molecular cytogenetic analysis of mosaic small supernumerary marker chromosome 1 [sSMC(1)]. We review the literature of sSMC(1) at amniocentesis and chromosome 1p21.1-p12 duplication syndrome. We discuss the genotype-phenotype correlation of the involved genes of ALX3, RBM15, NTNG1, SLC25A24, GPSM2, TBX15 and NOTCH2 in this case.

  16. 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)....

  17. Existence of inelastic supernumerary nuclear rainbow in 16O+12C scattering

    Science.gov (United States)

    Ohkubo, S.; Hirabayashi, Y.; Ogloblin, A. A.

    2017-08-01

    The existence of a supernumerary nuclear rainbow in inelastic scattering is reported. This is done by studying inelastic 16O scattering from 12C, exciting the 2+ (4.44 MeV) state of 12C and elastic scattering at the incident energies in the range 124-200 MeV, using the coupled channels method. An extended double folding potential is used. This is derived from realistic wave functions for 12C and 16O calculated with a microscopic α cluster model and a finite-range density-dependent nucleon-nucleon force. Excitations to the 2+ (4.44 MeV), 3- (9.64 MeV), and 4+ (14.08 MeV) states of 12C, and the 3- (6.13 MeV) and 2+ (6.92 MeV) states of 16O are included in the coupled channels calculations. The emergence of the supernumerary bow is understood by the properties of both the Luneburg-lens-like potential in the internal region and diffuse attraction in the outer region. The existence of a supernumerary rainbow for inelastic scattering in addition to the existence of a dynamically created secondary rainbow and a dynamically refracted primary rainbow for elastic scattering, which are not observed in meteorological rainbows, further deepens the understanding of nuclear rainbows.

  18. Under your nose: a rare finding during dissection provides insights into maxillary supernumerary teeth.

    Science.gov (United States)

    Redwood, C; Townsend, G C; Ghabriel, M; Brook, A H

    2014-09-01

    A supernumerary tooth was found during anatomical dissection. The position of this tooth, still impacted in the maxilla, and the associated pathology make this a rare case. During dissection by dental students of the sagittally-sectioned head of a cadaver, a supernumerary tooth was identified in the mid-palatal area. Further dissection revealed a swelling with a thin bony covering related to the crown of the tooth. The maxilla was removed en bloc and radiographic examination, CT scanning, electron microscopy and histology were undertaken. The tooth had a crenulated occlusal surface and a single root. It was 25 mm posterior to the root apex of the permanent upper central incisor. The swelling, confirmed by radiographs and CT imaging to be associated with the crown, occupied approximately one-third of the maxillary sinus. The 3D shape of the cystic lesion was visualized by a composite digital movie. The crown form, position of the tooth and the associated dentigerous cyst suggested it was a palatally developing supernumerary premolar which had been displaced to the palatal midline by the expanding cyst. This rare case highlights the learning and teaching opportunities available during dissection, showing important variations in both development and clinical anatomy. © 2014 Australian Dental Association.

  19. The Multidisciplinary Management of Fused Maxillary Lateral Incisor with a Supernumerary Tooth in Cleft Lip Adolescence

    Directory of Open Access Journals (Sweden)

    Ahmet Yagci

    2014-01-01

    Full Text Available Fusion, an uncommon anomaly of the hard dental tissues, is potentially the cause of clinical problems related to esthetics, tooth spacing, and other periodontal complications. This paper describes a multidisciplinary approach involving surgical, endodontic, restorative, and orthodontic attention for the successful, functional, and esthetic rehabilitation of a maxillary left lateral incisor fused with a supernumerary tooth in unilateral cleft lip adolescence in contralateral side. After clinical and radiographic examinations, a fusion between the left maxillary lateral incisor and a supernumerary tooth was diagnosed in the patient, and a small connection was detected between the pulp systems of the two root canals. The case reported in this paper presents the successful resolution of a fused maxillary lateral incisor with a supernumerary tooth, using endodontic, surgical, restorative, and orthodontic management. The decision made in extracting or retaining the fused tooth depends on the arch discrepancy and esthetic needs. Future studies, with long-term followup, will be helpful in evaluating the long-term efficacy of the different treatment options.

  20. Classification of Phantom Finger, Hand, Wrist, and Elbow Voluntary Gestures in Transhumeral Amputees With sEMG.

    Science.gov (United States)

    Jarrasse, Nathanael; Nicol, Caroline; Touillet, Amelie; Richer, Florian; Martinet, Noel; Paysant, Jean; de Graaf, Jozina Bernardina

    2017-01-01

    Decoding finger and hand movements from sEMG electrodes placed on the forearm of transradial amputees has been commonly studied by many research groups. A few recent studies have shown an interesting phenomenon: simple correlations between distal phantom finger, hand and wrist voluntary movements and muscle activity in the residual upper arm in transhumeral amputees, i.e., of muscle groups that, prior to amputation, had no physical effect on the concerned hand and wrist joints. In this study, we are going further into the exploration of this phenomenon by setting up an evaluation study of phantom finger, hand, wrist and elbow (if present) movement classification based on the analysis of surface electromyographic (sEMG) signals measured by multiple electrodes placed on the residual upper arm of five transhumeral amputees with a controllable phantom limb who did not undergo any reinnervation surgery. We showed that with a state-of-the-art classification architecture, it is possible to correctly classify phantom limb activity (up to 14 movements) with a rather important average success (over 80% if considering basic sets of six hand, wrist and elbow movements) and to use this pattern recognition output to give online control of a device (here a graphical interface) to these transhumeral amputees. Beyond changing the way the phantom limb condition is apprehended by both patients and clinicians, such results could pave the road towards a new control approach for transhumeral amputated patients with a voluntary controllable phantom limb. This could ease and extend their control abilities of functional upper limb prosthetics with multiple active joints without undergoing muscular reinnervation surgery.

  1. Restless legs symptoms in a patient with above knee amputations: a case of phantom restless legs.

    Science.gov (United States)

    Hanna, Philip A; Kumar, Sanjeev; Walters, Arthur S

    2004-01-01

    We describe a 78-year-old gentleman who, following bilateral above-knee amputations, developed symptoms of restless legs syndrome in the absent portions of his lower extremities. These symptoms improved with dopamine agonist therapy. In addition, he later developed parkinsonism with prominent rest tremor on metoclopramide. This suggests that this individual had a dopamine-deficient state which predisposed him to both restless legs syndrome and drug-induced or drug-exacerbated parkinsonism. We propose expanding the spectrum of phantom limb phenomena to include phantom restless legs.

  2. Phantom pain : A sensitivity analysis

    NARCIS (Netherlands)

    Borsje, Susanne; Bosmans, JC; Van der Schans, CP; Geertzen, JHB; Dijkstra, PU

    2004-01-01

    Purpose : To analyse how decisions to dichotomise the frequency and impediment of phantom pain into absent and present influence the outcome of studies by performing a sensitivity analysis on an existing database. Method : Five hundred and thirty-six subjects were recruited from the database of an o

  3. Influence of adjustments to amputation and artificial limb on quality of life in patients following lower limb amputation.

    Science.gov (United States)

    Sinha, Richa; van den Heuvel, Wim J A; Arokiasamy, Perianayagam; van Dijk, Jitse P

    2014-03-01

    The objectives of this study are to investigate the relationship between adjustments to amputation and artificial limb, and quality of life (QoL), and to analyse the influence of sociodemographic, medical and amputation-related factors on this relationship. Patients with unilateral and noncongenital lower limb amputation who were using artificial limb were interviewed (n=368) using structured questionnaires. The Trinity Amputation and Prosthesis Experience Scales (TAPES) were used to assess adjustments to amputation and artificial limb and the MOS Short-Form Health Survey (SF-36) was used to assess the physical (PCS) and mental (MCS) component summary of QoL. Absence of comorbidity and residual stump pain, being employed, young age, less functional restriction, being more adjusted to limitation, increased social adjustment and less restriction in athletic activity were related to better PCS scores. Absence of comorbidity and phantom limb pain, nonuse of assistive device, being more adjusted to limitation, increased social adjustment and being less functionally restricted were related to higher MCS scores. Comorbidity had a modifying effect on both PCS and MCS scores. In addition, age, being employed and residual stump pain had a modifying influence on PCS, whereas assistive device use and phantom limb pain had a modifying influence on MCS. Our findings show that TAPES subscales have a modifying effect on the associations between several background (sociodemographic and amputation characteristics) and QoL (PCS and MCS). This indicates that adjustments to amputation and artificial limb are the key determinants of QoL in individuals following lower limb amputation.

  4. Experimental induction of a perceived telescoped limb using a full-body illusion

    Directory of Open Access Journals (Sweden)

    Laura eSchmalzl

    2011-04-01

    Full Text Available Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as telescoped with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin’s stump with respect to the participants’ hand we were able to evoke the sensation of the participants’ hand being located either below the stump or, more crucially, inside the stump, i.e. telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift. Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and

  5. A comparative study on patient specific absolute dosimetry using slab phantom, acrylic body phantom and goat head phantom

    Directory of Open Access Journals (Sweden)

    Om Prakash Gurjar

    2015-01-01

    Full Text Available Purpose: To compare the results of patient specific absolute dosimetry using slab phantom, acrylic body phantom and goat head phantom. Methods: Fifteen intensity modulated radiotherapy (IMRT plans already planned on treatment planning system (TPS for head-and-neck cancer patients were exported on all three kinds of phantoms viz. slab phantom, acrylic body phantom and goat head phantom, and dose was calculated using anisotropic analytic algorithm (AAA. All the gantry angles were set to zero in case of slab phantom while set to as it is in actual plan in case of other two phantoms. All the plans were delivered by linear accelerator (LA and dose for each plan was measured by 0.13 cc ion chamber. The percentage (% variations between planned and measured doses were calculated and analyzed. Results: The mean % variations between planned and measured doses of all IMRT quality assurance (QA plans were as 0.65 (Standard deviation (SD: 0.38 with confidence limit (CL 1.39, 1.16 (SD: 0.61 with CL 2.36 and 2.40 (SD: 0.86 with CL 4.09 for slab phantom, acrylic head phantom and goat head phantom respectively. Conclusion: Higher dose variations found in case of real tissue phantom compare to results in case of slab and acrylic body phantoms. The algorithm AAA does not calculate doses in heterogeneous medium as accurate as it calculates in homogeneous medium. Therefore the patient specific absolute dosimetry should be done using heterogeneous phantom mimicking density wise as well as design wise to the actual human body.  

  6. Prevalence of supernumerary teeth in permanent dentition among patients attending a dental college in South Kerala: A pilot study

    Directory of Open Access Journals (Sweden)

    Devi Gopakumar

    2014-01-01

    Full Text Available Background: Supernumerary teeth are excess number of teeth formed as a result of disturbances occurring during odontogenesis. The objective of the study was to investigate the prevalence of supernumerary teeth in permanent dentition among patients attending a dental college in South Kerala. Materials and Methods: In this study, 11,141 subjects attending the out-patient department of PMS College of Dental Science and Research, Thiruvananthapuram, Kerala were examined for supernumerary teeth like mesiodens, paramolars, distomolars, third premolars, second laterals, and odontomes during the period May 2012-May 2013. Ethical clearance was obtained from the institutional ethical committee for the study. Results: The study showed a prevalence of 0.39% and a sex distribution of M:F equal to 2:1. The incidence of supernumerary teeth found was as follows: mesiodens (0.14%, paramolars (0.13%, third premolar (0.04%, distomolar (0.03%, extralateral (0.02%, and odontome (0.03%. The male:female gender predilection was as follows: mesiodens (3:1, paramolars (1.3:1, third premolar (4:1, distomolar (1:2, and odontome (2:1. Conclusion: This study showed a 0.39% prevalence of supernumerary teeth in this population.

  7. Phantom Dark Energy and its Cosmological Consequences

    CERN Document Server

    Dabrowski, Mariusz P

    2016-01-01

    I discuss the dark energy characterized by the violation of the null energy condition ($\\varrho + p \\geq 0$), dubbed phantom. Amazingly, it is admitted by the current astronomical data from supernovae. We discuss both classical and quantum cosmological models with phantom as a source of matter and present the phenomenon called phantom duality.

  8. 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...

  9. Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis

    Directory of Open Access Journals (Sweden)

    Hameed Anam

    2010-11-01

    Full Text Available Abstract Background Ectopic eruption of teeth in non-dental sites is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, ostiomeatal complex disease and facial numbness. However, presentation of such patients with recurrent haemoptysis has not been described in the literature so far. We have described a case of an ectopic, supernumerary molar tooth in the maxillary antrum in a patient who initially presented with haemoptysis. Case presentation A 45-year-old male presented with a 2-month history of episodic haemoptysis. A pedunculated growth from the inferior nasal turbinate was seen with fibre-optic visualization. Although the patient was empirically started on antibiotic and anti-allergic therapy, there was no improvement after a few weeks and the patient had recurrent episodes of haemoptysis. Fibre-optic visualization was repeated showing bilateral osteomeatal erythema. Computed tomography scan of the paranasal sinuses demonstrated complete opacification of the left maxillary antrum along with a focal area of density comparable to bone. An ectopic, supernumerary molar tooth was found in the left maxillary antrum on endoscopic examination and subsequently removed. In addition, copious purulent discharge was seen. Post-operatively, the patient was treated with a 10-day course of oral amoxicillin-clavulanate. On follow-up, he reported resolution of symptoms. Conclusion Recurrent haemoptysis has not been described as a presentation for a supernumerary, ectopic tooth in literature before. We recommend that in patients with sinusitis-type of opacification of maxillary antrum and whose condition is refractory to conventional medical treatment, consideration should be given to the investigation of possible underlying anomalies as the cause of such symptoms. Presence of foreign bodies and ectopic teeth in paranasal sinuses can be reliably excluded with the use

  10. Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis.

    Science.gov (United States)

    Saleem, Taimur; Khalid, Umair; Hameed, Anam; Ghaffar, Shehzad

    2010-11-11

    Ectopic eruption of teeth in non-dental sites is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, ostiomeatal complex disease and facial numbness. However, presentation of such patients with recurrent haemoptysis has not been described in the literature so far. We have described a case of an ectopic, supernumerary molar tooth in the maxillary antrum in a patient who initially presented with haemoptysis. A 45-year-old male presented with a 2-month history of episodic haemoptysis. A pedunculated growth from the inferior nasal turbinate was seen with fibre-optic visualization. Although the patient was empirically started on antibiotic and anti-allergic therapy, there was no improvement after a few weeks and the patient had recurrent episodes of haemoptysis. Fibre-optic visualization was repeated showing bilateral osteomeatal erythema. Computed tomography scan of the paranasal sinuses demonstrated complete opacification of the left maxillary antrum along with a focal area of density comparable to bone. An ectopic, supernumerary molar tooth was found in the left maxillary antrum on endoscopic examination and subsequently removed. In addition, copious purulent discharge was seen. Post-operatively, the patient was treated with a 10-day course of oral amoxicillin-clavulanate. On follow-up, he reported resolution of symptoms. Recurrent haemoptysis has not been described as a presentation for a supernumerary, ectopic tooth in literature before. We recommend that in patients with sinusitis-type of opacification of maxillary antrum and whose condition is refractory to conventional medical treatment, consideration should be given to the investigation of possible underlying anomalies as the cause of such symptoms. Presence of foreign bodies and ectopic teeth in paranasal sinuses can be reliably excluded with the use of appropriate radiological imaging and endoscopic examination.

  11. Illusory movements of a phantom hand grade with the duration and magnitude of motor commands.

    Science.gov (United States)

    Walsh, Lee D; Gandevia, Simon C; Taylor, Janet L

    2010-04-15

    The senses of limb movement and position are critical for accurate control of movement. Recent studies show that central signals of motor command contribute to the sense of limb position but it is not clear whether such signals influence the distinctly different sense of limb movement. Nine subjects participated in two experiments in which we inflated a cuff around their upper arm to produce an ischaemic block, paralysing and anaesthetising the forearm, wrist and hand. This produces an experimental phantom wrist and hand. With their arm hidden from view subjects were asked to make voluntary efforts with their blocked wrist. In the first experiment, efforts were 20 and 40% of maximum and were 2 and 4 s in duration. The second experiment used 1 and 5 s efforts of 5 and 50% of maximum. Subjects signalled perceived movements of their phantom wrist using a pointer. All subjects reported clear perceptions of movement of their phantom hand for all levels and durations of effort. On average, subjects perceived their phantom wrist to move between 16.4 +/- 3.3 deg (mean +/- 95% confidence interval (CI)) and 30.2 +/- 5.4 deg in the first experiment and between 10.3 +/- 3.5 and 38.6 +/- 6.7 deg in the second. The velocity of the movements and total displacement of the phantom graded with the level of effort, and the total displacement also graded with duration. Hence, we have shown that motor command signals have a novel proprioceptive role in the perception of movement of human joints.

  12. Multiple bilateral supernumerary mandibular premolars in a non-syndromic patient with associated orthokeratised odontogenic cyst- A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Vikrant O Kasat

    2012-01-01

    Full Text Available Multiple supernumerary teeth are very rare, accounting for less than 1% of cases. They are commonly associated with syndromes like Gardner′s syndrome and cleidocranial dysostosis and cleft lip and palate. Non-syndromic multiple supernumerary teeth have a predilection to occur in the mandibular premolar region. Orthokeratinized odontogenic cyst (OOC is a relatively uncommon developmental cyst comprising about 10% of the cases that had been previously implied as odontogenic keratocysts. More than half of the cases of OOC are associated with impacted tooth; but not a single case of OOC associated with supernumerary teeth is reported. Hence, the purpose of this article is to report the first case of multiple supernumerary mandibular premolars associated with OOC in a 35-year-old male and to review the literature associated with multiple bilateral supernumerary mandibular premolars.

  13. Complex Lagrangians and phantom cosmology

    CERN Document Server

    Andrianov, A A; Kamenshchik, A Yu

    2006-01-01

    Motivated by the generalization of quantum theory for the case of non-Hermitian Hamiltonians with PT symmetry, we show how a classical cosmological model describes a smooth transition from ordinary dark energy to the phantom one. The model is based on a classical complex Lagrangian of a scalar field. Specific symmetry properties analogous to PT in non-Hermitian quantum mechanics lead to purely real equation of motion.

  14. Double dens invaginatus in an impacted molariform supernumerary tooth: An unique case

    Directory of Open Access Journals (Sweden)

    Anegundi R

    2008-05-01

    Full Text Available Dens invaginatus is a relatively rare developmental anomaly affecting usually the permanent maxillary lateral incisor. Various factors have been put forward regarding its pathogenesis. Involvement of crown/root has been reported as the coronal and radicular variety of dens invaginatus. One of the rarest variant is the Double dens invaginatus and only a few cases have been reported in the literature.This article focuses on a case of double dens invaginatus in an impacted maxillary anterior supernumerary tooth, the associated complications and its management

  15. Small supernumerary marker chromosomes (sSMC) in humans; are there B chromosomes hidden among them

    OpenAIRE

    Ogilvie Caroline; Kosyakova Nadezda; Mrasek Kristin; Liehr Thomas; Vermeesch Joris; Trifonov Vladimir; Rubtsov Nikolai

    2008-01-01

    Abstract Background Small supernumerary marker chromosomes (sSMC) and B-chromosomes represent a heterogeneous collection of chromosomes added to the typical karyotype, and which are both small in size. They may consist of heterochromatic and/or euchromatic material. Also a predominance of maternal transmission was reported for both groups. Even though sSMC and B-chromosomes show some similarity it is still an open question if B-chromosomes are present among the heterogeneous group of sSMC. Ac...

  16. A comparison between various radiological techniques in the localization and analysis of impacted and supernumerary teeth

    Directory of Open Access Journals (Sweden)

    Christoph M Ziegler

    2013-01-01

    Full Text Available Background and Objectives: An increasing number of different types of commercial cone-beam computed tomography (CBCT devices are available for three-dimensional (3D imaging in the field of dental and maxillofacial radiology. When removing impacted or supernumerary teeth, surgical teams often operate adjacent significant anatomical structures such as nerves, vessels, adjacent teeth roots, and paranasal sinuses. It is therefore important to choose the appropriate surgical approach to avoid iatrogenic damage to the essential anatomical neighbouring structures. CBCT, also called digital volume tomography (DVT, can visualize impacted and supernumerary teeth in all standard planes, as well as multisectional 3D views. These devices have shown to be highly beneficial in the assessment of small bony lesions and maxillofacial injuries. However, it is still necessary to determine the effectiveness of such devices in the assessment of impacted and supernumerary teeth, in comparison to the conventional radiological methods of intraoral X-rays and panoramic X-rays. Materials and Methods: During a period of 2 years, a total of 61 patients of whom majority had impacted teeth or supernumerary elements in the frontal maxillary region were studied with CBCT and treated at the St. Olavs University Hospital. Patients were referred to our Department of Oral and Maxillofacial Surgery with both conventional and digital intraoral X-rays and/or panoramic X-rays. None had any acute infections or odontogenic abscesses, and most presented with asymptomatic impacted tooth. A comparison between the preoperative conventional and the CBCT images, the resulting diagnoses, and the intraoperative findings as "gold standard" were made and recorded in a compiled scoring sheet. The objects of interest were researched with the magnification method. Each patient was identified only with a patient number. Results: In contrast to the conventional X-rays, the pre-surgical evaluation with

  17. Newborn with Supernumerary Marker Chromosome Derived from Chromosomes 11 And 22- A Case Report.

    Science.gov (United States)

    Vahidi Mehrjardi, Mohammad Yahya; Dehghan Tezerjani, Masoud; Nori-Shadkam, Mahmoud; Kalantar, Seyed Mehdi; Dehghani, Mohammadreza

    2016-03-01

    The interpretation of supernumerary chromosome is important for genetic counseling and prognosis. Here, we used SNP array and conventional karyotyping method to identify a denovo marker chromosome originated from chromosome 22 and 11 in a newborn transferred to the Neonatal Intensive Care Unit of Shahid Sadoughi Hospital in 2015. Clinical abnormalities identified in the newborn were dysmorphic face, intrauterine growth retardation, atrial septal defect (ASD), the hypoplasia of corpus callosum and septum pellucidum. These clinical abnormalities can be related to this marker, and it may help genetic counselor for predicting abnormality risk in susceptible individuals as well as prenatal diagnosis.

  18. Dioctophyme renale Goeze, 1782 in a cat with a supernumerary kidney

    Directory of Open Access Journals (Sweden)

    Daniela Pedrassani

    Full Text Available This study reports a case of parasitism by Dioctophyme renale in a supernumerary kidney and abdominal cavity of a female cat in Brazil. The three-year-old cat of indeterminate breed presented abdominal distension and was taken to the University of Contestado Veterinary Hospital in Canoinhas, state of Santa Catarina, since the owner suspected pregnancy. An ultrasound scan did not confirm pregnancy but revealed parasitism in the kidney. This case is worth reporting because domestic cats are rarely hosts of this nematode species.

  19. Dioctophyme renale Goeze, 1782 in a cat with a supernumerary kidney.

    Science.gov (United States)

    Pedrassani, Daniela; Wendt, Hamilton; Rennau, Erley Alexandre; Pereira, Samuel Tibes; Wendt, Simone Balão Taques

    2014-03-01

    This study reports a case of parasitism by Dioctophyme renale in a supernumerary kidney and abdominal cavity of a female cat in Brazil. The three-year-old cat of indeterminate breed presented abdominal distension and was taken to the University of Contestado Veterinary Hospital in Canoinhas, state of Santa Catarina, since the owner suspected pregnancy. An ultrasound scan did not confirm pregnancy but revealed parasitism in the kidney. This case is worth reporting because domestic cats are rarely hosts of this nematode species.

  20. Mandibular midline supernumerary tooth associated with agenesis of permanent central incisors: a diagnostic conundrum.

    Science.gov (United States)

    Marya, Charu Mohan; Sharma, Gaurav; Parashar, Vijay P; Dahiya, Vandana; Gupta, Anil

    2012-01-01

    Concomitant hypo-hyperdontia is a rare mixed numeric anomalous condition. The presence of this condition in the same area of dental arch and specifically in the mandibular anterior region is reported very infrequently. This case report presents a case of 20 years old male with congenitally missing permanent mandibular central incisors in conjunction with a mandibular midline supernumerary tooth. Only 3 cases have been documented in English literature till date. The article focuses on the review of mandibular mesiodens and the clarity regarding the usage of the terminology "mesiodens".

  1. Pindborg tumor arising in association with an impacted supernumerary tooth in the anterior maxilla.

    Science.gov (United States)

    Waingade, Manjushri; Gawande, Pushkar; Aditya, Amita; Medikeri, Raghavendra S

    2014-06-01

    Pindborg tumor/Calcifying Epithelial Odontogenic Tumor (CEOT) is a benign epithelial odontogenic tumor which shows locally aggressive behavior and accounts for less than 1% of all odontogenic tumors. The most frequent location is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla. Since histopathology remains the main method for definitive diagnosis, this lesion presents an enigma to a clinician when lesions occur in atypical locations. The authors report a case of CEOT in the maxillary anterior region associated with an impacted supernumerary tooth (mesiodens).

  2. The role of the environment in eliciting phantom-like sensations in non-amputees

    Directory of Open Access Journals (Sweden)

    Elizabeth eLewis

    2013-01-01

    Full Text Available Following the amputation of a limb, many amputees report that they can still vividly perceive its presence despite conscious knowledge that it is not physically there. However, our ability to probe the mental representation of this experience is limited by the intractable and often distressing pain associated with amputation. Here, we present a method for eliciting phantom-like experiences in non-amputees using a variation of the rubber hand illusion in which a finger has been removed from the rubber hand. An interpretative phenomenological analysis revealed that the structure of this experience shares a wide range of sensory attributes with subjective reports of phantom limb experience. For example, when the space where the ring finger should have been on the rubber hand was stroked, 93% of participants (i.e., 28/30 reported the vivid presence of a finger that they could not see and a total of 57% (16/28 of participants who felt that the finger was present reported one or more additional sensory qualities such as tingling or numbness (25%; 7/28 and alteration in the perceived size of the finger (50%; 14/28. These experiences indicate the adaptability of body experience and share some characteristics of the way that phantom limbs are described. Participants attributed changes to the shape and size of their ‘missing’ finger to the way in which the experimenter mimed stroking in the area occupied by the missing finger. This alteration of body perception is similar to the phenomenon of telescoping experienced by people with phantom limbs and suggests that our sense of embodiment not only depends on internal body representations but on perceptual information coming from peripersonal space.

  3. Prevalence and characterıstıcs of supernumerary teeth in a child population from Central Anatolıa - Turkey.

    Science.gov (United States)

    Arikan, Volkan; Ozgul, Betul Memis; Firdevs, Tulga O Z

    2013-12-01

    This article aimed to characterize the incidence of supernumerary teeth in Turkish children according to sex, location, number and morphology and to explore possible correlations between these variables. The study population comprised 7,551 non-syndromic patients aged 3-16 years who applied for routine check-ups at the Ankara University Department of Pediatric Dentistry between January 2009 and January 2010. The population included children in deciduous, mixed and permanent dentition. Both clinical and radiographic examinations were conducted. Demographic variables (age, sex) as well as number, location (maxilla or mandible), position, type and morphology of supernumeraries were recorded for all patients with supernumerary teeth. Supernumerary teeth with odontomes were also noted. Of the 7,551 patients examined, supernumerary teeth were detected in 74 patients (0.98%). Of these, 48 were male and 26 were female (male-to-female ratio: 1.84:1). A total of 84 supernumerary teeth were detected, 80 (95.2%) of which were permanent teeth and 4 (4.8%) of which were deciduous teeth (n=4). Most supernumerary teeth (n=59, 70.2%) were located in the maxillary arch. The most common supernumerary teeth were mesiodens (36.9%), followed by supernumerary teeth located in the maxillary incisor region (33.3%), the mandibular premolar region (17.9%), the mandibular molar region (5.9%), the mandibular incisor region (4.8%) and the mandibular canine region (1.2%). The prevalence of supernumerary teeth was found to be 0.98% and mesiodens was the most frequent type.

  4. 多发性多生牙1例%A case report of multiple supernumerary teeth

    Institute of Scientific and Technical Information of China (English)

    姜华

    2013-01-01

      多生牙的发生率占正常人群的1%~3%。多生牙常见于恒牙列,数目一般多见于1~3颗,5颗以上非常罕见。%Incidence of supernumerary teeth in total normal population is 1%-3%. Supernumerary teeth are com-mon in the permanent dentition, and 1-3 teeth are common, but more than 5 teeth are rare.

  5. 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

  6. 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

  7. Pain Management in Four-Limb Amputation: A Case Report.

    Science.gov (United States)

    Warner, Nafisseh S; Warner, Matthew A; Moeschler, Susan M; Hoelzer, Bryan C

    2015-09-01

    Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation. © 2015 World Institute of Pain.

  8. Paternal isodisomy of chromosome 6 in association with a maternal supernumerary marker chromosome (6)

    Energy Technology Data Exchange (ETDEWEB)

    James, R.S.; Crolla, J.A.; Sitch, F.L. [Salisbury District Hospital, Wiltshire (United Kingdom)] [and others

    1994-09-01

    Uniparental disomy may arise by a number of different mechanisms of aneuploidy correction. A population that has been identified as being at increased risk of aneuploidy are those individuals bearing supernumerary marker chromosomes (SMCs). There have been a number of cases reported of trisomy 21 in association with bi-satellited marker chromosomes have described two individuals with small inv dup (15) markers. One had paternal isodisomy of chromosome 15 and Angelman syndrome. The other had maternal heterodisomy (15) and Prader-Willi syndrome. At the Wessex Regional Genetics Laboratory we have conducted a search for uniparental disomy of the normal homologues of the chromosomes from which SMCs originated. Our study population consists of 39 probands with SMCs originating from a number of different autosomes, including 17 with SMCs of chromosome 15 origin. Using PCR amplification of microsatellite repeat sequences located distal to the regions included in the SMCs we have determined the parental origin of the two normal homologues in each case. We have identified paternal isodisomy of chromosome 6 in a female child with a supernumerary marker ring chromosome 6 in approximately 70% of peripheral blood lymphocytes. The marker was found to be of maternal origin. This is the second case of paternal isodisomy of chromosome 6 to be reported, and the first in association with a SMC resulting in a partial trisomy for a portion of the short arm of chromosome 6. In spite of this, the patient appears to be functioning appropriately for her age.

  9. Supernumerary Formation of Olfactory Glomeruli Induced by Chronic Odorant Exposure: A Constructivist Expression of Neural Plasticity

    Science.gov (United States)

    Valle-Leija, Pablo; Blanco-Hernández, Eduardo; Drucker-Colín, Rene; Gutiérrez-Ospina, Gabriel; Vidaltamayo, Roman

    2012-01-01

    It is accepted that sensory experience instructs the remodelling of neuronal circuits during postnatal development, after their specification has occurred. The story is less clear with regard to the role of experience during the initial formation of neuronal circuits, whether prenatal or postnatal, since this process is now supposed to be primarily influenced by genetic determinants and spontaneous neuronal firing. Here we evaluated this last issue by examining the effect that postnatal chronic exposure to cognate odorants has on the formation of I7 and M72 glomeruli, iterated olfactory circuits that are formed before and after birth, respectively. We took advantage of double knock-in mice whose I7 and M72 primary afferents express green fluorescent protein and β-galactosidase, correspondingly. Our results revealed that postnatal odorant chronic exposure led to the formation of permanent supernumerary I7 and M72 glomeruli in a dose and time dependent manner. Glomeruli in exposed mice were formed within the same regions of olfactory bulb and occupy small space volumes compared to the corresponding single circuits in non-exposed mice. We suggest that local reorganization of the primary afferents could participate in the process of formation of supernumerary glomeruli. Overall, our results support that sensory experience indeed instructs the permanent formation of specific glomeruli in the mouse olfactory bulb by means of constructivist processes. PMID:22511987

  10. Non-syndromic multiple impacted supernumerary teeth with peripheral giant cell granuloma

    Directory of Open Access Journals (Sweden)

    Pankaj Bansal

    2011-01-01

    Full Text Available Peripheral giant cell granuloma (PGCG is a relatively frequent benign reactive lesion of the gingiva, originating from the periosteum or periodontal membrane following local irritation or chronic trauma. PGCG manifests as a red-purple nodule located in the region of the gingiva or edentulous alveolar margins. The lesion can develop at any age, although it is more common between the second and third decades of life, and shows a slight female predilection. PGCG is a soft tissue lesion that very rarely affects the underlying bone, although the latter may suffer superficial erosion. A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. These teeth may be single, multiple, erupted or unerupted and may or may not be associated with syndrome. Usually, they cause one or the other problem in eruption or alignment of teeth, but may also present without disturbing the normal occlusion or eruption pattern. Management of these teeth depends on the symptoms. Presented here is a case of PGCG in relation to the lower left permanent first molar with three supernumerary teeth in the mandibular arch but no associated syndrome.

  11. Analyses of 1100 supernumerary teeth in a nonsyndromic Turkish population: A retrospective multicenter study.

    Science.gov (United States)

    Bereket, C; Çakır-Özkan, N; Şener, İ; Bulut, E; Baştan, A İ

    2015-01-01

    The aim of this study was to analyze the clinical and radiological features of supernumerary teeth (ST), record the related complications, and discuss different forms of treatment. A total of 111,293 patients were examined over a 3-year period. The patients' ages and genders, in addition to the number, morphology, location, position, shape, developmental stage, and eruption status of ST and associated complications, were recorded. Among the 111,293 patients, there were 851 (0.76%) patients with 1100 ST. Of these patients, 478 (56.2%) were males, and 373 (43.8%) were females, with a mean age of 22.71. Most of the 1100 ST were located in the maxilla, 437 (39.72%) were a conical shape, with 82.81% of these including a fully developed tooth. A mesiodens was the most common type of supernumerary tooth (n=284, 33.37%), followed by distomolars (n=204, 23.97%) and parapremolars (n=146, 17.16%). Among the 1100 ST, 422 (38.36%) were associated with complications. No previous studies in the literature have examined in detail so many cases with ST. The demographic profile of the patients with ST presented herein provides useful additional epidemiological information.

  12. A rare case of impacted supernumerary premolar causing resorption of mandibular first molar

    Directory of Open Access Journals (Sweden)

    R V Murali

    2015-01-01

    Full Text Available The management of patients with pain in today′s general practice has become a major concern and sometimes this pain is related to some rare causes. A male patient aged 26 years reported with pain in the lower left molar region (36 and then an intra-oral periapical radiograph (IOPA, and orthopantomograph was taken. IOPA revealed the presence of supernumerary premolar causing pressure and root resorption of 36. Also, there was missing 21 and proximal decay in 11. Eleven was treated endodontically, and then bridge was done in relation to 11, 21 and 22. Lower anterior crowding was also present. The treatment plan was to extract 36 followed by orthodontic extrusion of the supernumerary premolar and also the correction of lower anterior crowding. Hidden approach (lingual orthodontics was used as the patient was insisting upon the braces not being seen outside during the course of the treatment. Later all ceramic bridge was done in relation to 11, 21 and 22. Orthodontic tooth extrusion techniques offer excellent treatment options for Partially Impacted tooth. It is a well-documented clinical method for extruding sound tooth material from within the alveolar socket by light forces. The use of lingual technique for forced eruption enhance acceptance of orthodontic treatment by adults. The treatment of a young adult patient illustrates the importance of treatment planning from one discipline to another, communication among team members and the benefits of working together in an interdisciplinary approach

  13. Physical and social factors determining quality of life for veterans with lower-limb amputation(s)

    DEFF Research Database (Denmark)

    Christensen, Jan; Ipsen, Thomas; Doherty, Patrick

    2016-01-01

    , years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. Conclusions The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality...... amputation(s). Level of amputation, back pain severity, years of education, duration of phantom pain and severity of phantom pain have been found to be determining factors for HRQoL and should be taken into consideration when planning rehabilitation programs for veterans with lower-limb amputations.......Purpose Most veterans live for many years after their war-related traumatic lower-limb amputation, which is why understanding which factors influence health-related quality of life (HRQoL) remains important to their long-term management. The objective of this study was to perform a review...

  14. Exact solution of phantom dark energy model

    Institute of Scientific and Technical Information of China (English)

    Wang Wen-Fu; Shui Zheng-Wei; Tang Bin

    2010-01-01

    We investigate the phantom dark energy model derived from the scalar field with a negative kinetic term. By assuming a particular relation between the time derivative of the phantom field and the Hubble function, an exact solution of the model is constructed. Absence of the 'big rip' singularity is shown explicitly. We then derive special features of phantom dark energy model and show that its predictions are consistent with all astrophysical observations.

  15. Neutron dosimetry in solid water phantom

    Energy Technology Data Exchange (ETDEWEB)

    Benites-Rengifo, Jorge Luis, E-mail: jlbenitesr@prodigy.net.mx [Centro Estatal de Cancerologia de Nayarit, Calzada de la Cruz 118 Sur, Tepic Nayarit, Mexico and Instituto Tecnico Superior de Radiologia, ITEC, Calle Leon 129, Tepic Nayarit (Mexico); Vega-Carrillo, Hector Rene, E-mail: fermineutron@yahoo.com [Universidad Autonoma de Zacatecas, Unidad Academica de Estudios Nucleares, Apdo. postal 336, 98000, Zacatecas, Zac. (Mexico)

    2014-11-07

    The neutron spectra, the Kerma and the absorbed dose due to neutrons were estimated along the incoming beam in a solid water phantom. Calculations were carried out with the MCNP5 code, where the bunker, the phantom and the model of the15 MV LINAC head were modeled. As the incoming beam goes into the phantom the neutron spectrum is modified and the dosimetric values are reduced.

  16. Clinical Report of 1 Cases of Monozygotic Twins Supernumerary Teeth%单卵双胞胎兄弟额外牙1例

    Institute of Scientific and Technical Information of China (English)

    杨春敏

    2014-01-01

    额外牙是指牙数目异常,其发生可能来自形成过多的牙蕾,也可能是牙胚分裂而成。临床上最多见的是上前牙区单颗多生牙。单卵双胞胎同患多生牙未见报道,同时含有2颗或多颗多生牙者更少见。近日笔者遇到一对双胞胎兄弟,因上前牙区多生牙影响美观前来就诊,由此正确的诊断及时拔除额外牙具有临床意义。%Supernumerary tooth is tooth abnormalities, which may be derived from the formation of excessive tooth bud, may also be split into tooth germ. Clinical go up to see at most is the anterior teeth area single supernumerary teeth. Monozygotic twins with supernumerary teeth is not reported, while containing two or more supernumerary teeth are more rare. I recently met a pair of twin brothers, because to supernumerary teeth appearance came to visit, report as fol ows now.Because the forward supernumerary teeth af ect the appearance to come round to see a doctor, the clinical significance of the correct diagnosis and timely removal of supernumerary teeth. Report as fol ows now.

  17. Molecular cytogenetic characterization of a small, familial supernumerary ring chromosome 7 associated with mental retardation and an abnormal phenotype

    NARCIS (Netherlands)

    Tan-Sindhunata, G; Castedo, S; Leegte, B; Mulder, [No Value; van der Veen, AYV; van der Hout, AHV; van Essen, AJ

    2000-01-01

    A family is described in which a mother and two of her children were mosaic for a small supernumerary ring chromosome. As the origin of the ring chromosome could not be determined by routine cytogenetic studies, fluorescent in situ hybridization was performed, which indicated that the ring chromosom

  18. Low grade mosaic for a complex supernumerary ring chromosome 18 in an adult patient with multiple congenital anomalies

    NARCIS (Netherlands)

    L.T. van der Veken (Lars); M.M.J. Dieleman (Marianne); H. Douben (Hannie); J.C. van de Brug (Judith); R. van de Graaf (Raoul); A.J.M. Hoogeboom; P.J. Poddighe (Pino); J.E.M.M. de Klein (Annelies)

    2010-01-01

    textabstractBackground. Several cases have been reported of patients with a ring chromosome 18 replacing one of the normal chromosomes 18. Less common are patients with a supernumerary ring chromosomes 18. High resolution whole genome examination in patients with multiple congenital abnormalities mi

  19. Phenotypic Spectrum of 20 Novel Patients With Molecularly Defined Supernumerary Marker Chromosomes 15 and a Review of the Literature

    NARCIS (Netherlands)

    Kleefstra, Tjitske; de Leeuw, Nicole; Wolf, Roy; Nillesen, Willy M.; Schobers, Gaby; Mieloo, Hanneke; Willemsen, Marjolein; Perrotta, Concetta Simona; Poddighe, Pino J.; Feenstra, Ilse; Draaisma, Jos; van Ravenswaaij-Arts, Conny M. A.

    Supernumerary marker chromosomes (SMC) originating from chromosome 15 are the most common SMCs. They encompass clinically irrelevant SMC(15)s containing only heterochromatin and 15p material, and clinically relevant SMC(15)s that consist of both eu- and heterochromatic 15q material. On the basis of

  20. Phenotypic Spectrum of 20 Novel Patients With Molecularly Defined Supernumerary Marker Chromosomes 15 and a Review of the Literature

    NARCIS (Netherlands)

    Kleefstra, Tjitske; de Leeuw, Nicole; Wolf, Roy; Nillesen, Willy M.; Schobers, Gaby; Mieloo, Hanneke; Willemsen, Marjolein; Perrotta, Concetta Simona; Poddighe, Pino J.; Feenstra, Ilse; Draaisma, Jos; van Ravenswaaij-Arts, Conny M. A.

    2010-01-01

    Supernumerary marker chromosomes (SMC) originating from chromosome 15 are the most common SMCs. They encompass clinically irrelevant SMC(15)s containing only heterochromatin and 15p material, and clinically relevant SMC(15)s that consist of both eu- and heterochromatic 15q material. On the basis of

  1. Galileons, phantom and the Fate of Universe

    CERN Document Server

    Shahalam, M; Myrzakulov, R

    2016-01-01

    In this paper we study cosmological dynamics of phantom as well as non-phantom fields with linear potential in presence of Galileon correction $(\\partial_\\mu\\phi \\partial^\\mu\\phi) \\Box \\phi$. We show that the Big Crunch singularity is delayed compared to the standard case; the delay crucially depends upon the strength of Galileon correction. As for the phantom Galileon, $\\rho_{\\phi}$ is shown to grow more slowly compared to the standard phantom delaying the approach to singularity. In case, $V\\sim \\phi^n, n>4$, Big Rip is also delayed, similar phenomenon is shown to take place for potentials steeper than the exponential.

  2. Do Phantom Cuntz-Krieger Algebras Exist?

    DEFF Research Database (Denmark)

    Arklint, Sara E.

    2013-01-01

    If phantom Cuntz-Krieger algebras do not exist, then purely infinite Cuntz-Krieger algebras can be characterized by outer properties. In this survey paper, a summary of the known results on non-existence of phantom Cuntz-Krieger algebras is given......If phantom Cuntz-Krieger algebras do not exist, then purely infinite Cuntz-Krieger algebras can be characterized by outer properties. In this survey paper, a summary of the known results on non-existence of phantom Cuntz-Krieger algebras is given...

  3. 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,…

  4. 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,…

  5. Do you believe in phantoms?

    CERN Multimedia

    Rosaria Marraffino

    2015-01-01

    “Phantoms” are tools that simulate a therapy’s response by mimicking the conditions of the human body. They are required in hadron therapy in order to optimise and verify the therapy before performing it on the patient. The better the phantom, the more accurate the treatment plan and the more effective the therapy. In the framework of the EU-funded project ENTERVISION*, a team of CERN researchers has designed an innovative piece of equipment able to evaluate radiobiology-related parameters in a very accurate way.   The ENTERVISION phantom being tested at HIT. A key challenge in hadron therapy – i.e. the medical use of hadrons to treat cancer – is to evaluate the biological effect of the delivered radiation. This can be achieved by using accurate dosimetry techniques to study the biological response in terms of the dose deposited and other physical parameters of the beam, such as the Linear Energy Transfer (LET). The job of the “phan...

  6. Transorbital therapy delivery: phantom testing

    Science.gov (United States)

    Ingram, Martha-Conley; Atuegwu, Nkiruka; Mawn, Louise; Galloway, Robert L.

    2011-03-01

    We have developed a combined image-guided and minimally invasive system for the delivery of therapy to the back of the eye. It is composed of a short 4.5 mm diameter endoscope with a magnetic tracker embedded in the tip. In previous work we have defined an optimized fiducial placement for accurate guidance to the back of the eye and are now moving to system testing. The fundamental difficulty in testing performance is establishing a target in a manner which closely mimics the physiological task. We have to have a penetrable material which obscures line of sight, similar to the orbital fat. In addition we need to have some independent measure of knowing when a target has been reached to compare to the ideal performance. Lastly, the target cannot be rigidly attached to the skull phantom since the optic nerve lies buried in the orbital fat. We have developed a skull phantom with white cloth stellate balls supporting a correctly sized globe. Placed in the white balls are red, blue, orange and yellow balls. One of the colored balls has been soaked in barium to make it bright on CT. The user guides the tracked endoscope to the target as defined by the images and tells us its color. We record task accuracy and time to target. We have tested this with 28 residents, fellows and attending physicians. Each physician performs the task twice guided and twice unguided. Results will be presented.

  7. Development of a HIFU Phantom

    Science.gov (United States)

    King, Randy L.; Herman, Bruce A.; Maruvada, Subha; Wear, Keith A.; Harris, Gerald R.

    2007-05-01

    The field of high intensity focused ultrasound (HIFU) is developing rapidly. For basic research, quality control, and regulatory assessment a reusable phantom that has both thermal and acoustic properties close to that of soft tissue is critical. A hydrogel-based tissue mimicking material (TMM) has been developed that shows promise for such a phantom. The acoustic attenuation, speed of sound, B/A, thermal diffusivity and conductivity, as well as the cavitation threshold, were measured and found to mimic published values for soft tissue. The attenuation of 0.53f1.04 from 1 MHz to 8 MHz, as well as the sound speed of 1565 m/s and the tissue-like image quality, indicate the usefulness of the TMM for ultrasound imaging applications. These properties along with the thermal conductivity of 0.58 W/m- °C, diffusivity of 0.15 (mm2)/s, and the ability to withstand temperatures above 95 °C make this material appropriate for HIFU applications. The TMM also allows for the embedding of thermocouples and the formation of wall-less vessels that do not deteriorate as a result of continuous flow of blood mimicking fluids through the material. Tissue characteristics are strongly dependent on the fabrication technique, and care must be taken to achieve reproducible results. Note: This research was supported by the Defense Advanced Research Projects Agency (DARPA).

  8. Unifying phantom inflation with late-time acceleration: scalar phantom-non-phantom transition model and generalized holographic dark energy

    CERN Document Server

    Nojiri, S; Nojiri, Shin'ichi; Odintsov, Sergei D.

    2005-01-01

    The unifying approach to early-time and late-time universe based on phantom cosmology is proposed. We consider gravity-scalar system which contains usual potential and scalar coupling function in front of kinetic term. As a result, the possibility of phantom-non-phantom transition appears in such a way that universe could have effectively phantom equation of state at early time as well as at late time. In fact, the oscillating universe may have several phantom and non-phantom phases. As a second model we suggest generalized holographic dark energy where infrared cutoff is identified with combination of FRW parameters: Hubble constant, particle and future horizons, cosmological constant and universe life-time (if finite). Depending on the specific choice of the model the number of interesting effects occur: the possibility to solve the coincidence problem, crossing of phantom divide and unification of early-time inflationary and late-time accelerating phantom universe. The bound for holographic entropy which d...

  9. Phantom pain and risk factors : A multivariate analysis

    NARCIS (Netherlands)

    Dijkstra, PU; Geertzen, JHB; Stewart, R; van der Schans, CP

    2002-01-01

    Phantom pain has been given considerable attention in literature. Phantom Pain reduces quality of life, and patients suffering from phantom pain make heavy use of the medical system. Many risk factors have been identified for phantom Pain in univariate analyses, including phantom sensations, stump P

  10. Phantom pain and risk factors : A multivariate analysis

    NARCIS (Netherlands)

    Dijkstra, PU; Geertzen, JHB; Stewart, R; van der Schans, CP

    2002-01-01

    Phantom pain has been given considerable attention in literature. Phantom Pain reduces quality of life, and patients suffering from phantom pain make heavy use of the medical system. Many risk factors have been identified for phantom Pain in univariate analyses, including phantom sensations, stump P

  11. Fibroadenoma in Axillary Supernumerary Breast in a 17-Year-Old Girl: Case Report.

    Science.gov (United States)

    Surd, Adrian; Mironescu, Aurel; Gocan, Horatiu

    2016-10-01

    Supernumerary breast or polymastia is a well documented anomaly of the breast, and commonly presents along the embryonic milk line extending between the axilla and groin. However, cases of polymastia have been recorded in the face, vulva, and perineum. The clinical significance of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems. In this article we report a case of fibroadenoma that developed in the supernumerary breast of the right axilla in a 17-year-old girl. It is uncommon to find such palpable masses in young patients. Clinical and sonographic examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue. In this report, we describe a rare case of fibroadenoma in an accessory breast in a young woman. There are a fewer than 40 reports in the world about this subject, of which differential diagnoses include: cancer in axillary supernumerary breast, hidradenitis, axillary lymphadenomegaly, lipomas, anexial cutaneous neoplasia, cysts, and phylloides tumor. The combination of clinical examination, ultrasound, and cytology leads to adequate treatment, especially surgical. The diagnosis could be confused because of findings from cytology. In this case, because of the clinical and sonographic findings and multiple differential diagnosis, only the histopathological study was used to confirm the diagnosis. Despite its high sensitivity, cytology has low specificity and could create false positive results. However, atypical lesions can be seen in fibroadenomas, especially in younger patients, pregnant patients, and in patients who use hormonal

  12. 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 ...

  13. Supernumerary rainbows

    Science.gov (United States)

    Sawicki, Mikolaj; Sawicki, Pawel

    2000-01-01

    Late in the afternoon of July 19, 1999, we were able to photograph some very unusual rainbows in the sky over Boulder, Colorado. The picture here shows a primary rainbow, a fainter secondary bow above it, and several pastel-shaded rainbows inside the primary one. While we think we counted as many as four concurrent rainbows in that afternoon, only three of them show up in developed prints.

  14. 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.

  15. Oscillating phantom in $F(R)$ gravity

    CERN Document Server

    Bamba, Kazuharu

    2009-01-01

    We investigate the oscillating effective equation of state (EoS) of the universe around the phantom divide in the framework of $F(R)$ gravity. We illustrate the behavior of $F(R)$ with realizing multiple crossings of the phantom divide.

  16. Note on the Schwarzschild-phantom wormhole

    Science.gov (United States)

    Lukmanova, R.; Khaibullina, A.; Izmailov, R.; Yanbekov, A.; Karimov, R.; Potapov, A. A.

    2016-11-01

    Recently, it has been shown by Lobo, Parsaei and Riazi that phantom energy with ω =pr/ρ Katz and Bi čák. It turns out that, even though the interior mass is positive, the integral implies repulsive energy. This is consistent with the phantom nature of interior matter.

  17. Resin phantoms as skin simulating layers

    CSIR Research Space (South Africa)

    Karsten, AE

    2011-07-01

    Full Text Available on the efficiency of Photodynamic Therapy (PDT) treatment. Two resin based solid phantoms were prepared to simulate two different skin types. Cells were prepared and PDT treatment were done on cells with and without the phantoms, by keeping the total dose delivered...

  18. Paradental cyst associated with supernumerary tooth fused with third molar: A rare case report

    Directory of Open Access Journals (Sweden)

    A Ravi Prakash

    2012-01-01

    Full Text Available Fusion is the union of two tooth buds that are normally separated. Fusion is more frequent in deciduous teeth, particularly in the anterior region. The etiology of fusion is not known. It has been suggested that the pressure of adjacent dental follicles produces their contact and fusion before calcification. There is no difference between men and women in incidence. The term paradental cyst means that such type of cysts that are close proximity with the root of a tooth. A history of recurrent pericoronitis is reported usually and there is often the presence of a communication between the periodontal pocket and the cyst. We present a rare case report where in partially erupted mandibular third molar is fused horizontally with a supernumerary tooth with paradental cyst.

  19. Paradental cyst associated with supernumerary tooth fused with third molar: A rare case report

    Science.gov (United States)

    Prakash, A Ravi; Reddy, P Sreenivas; Rajanikanth, M

    2012-01-01

    Fusion is the union of two tooth buds that are normally separated. Fusion is more frequent in deciduous teeth, particularly in the anterior region. The etiology of fusion is not known. It has been suggested that the pressure of adjacent dental follicles produces their contact and fusion before calcification. There is no difference between men and women in incidence. The term paradental cyst means that such type of cysts that are close proximity with the root of a tooth. A history of recurrent pericoronitis is reported usually and there is often the presence of a communication between the periodontal pocket and the cyst. We present a rare case report where in partially erupted mandibular third molar is fused horizontally with a supernumerary tooth with paradental cyst. PMID:22434950

  20. Cleidocranial dysplasia presenting with retained deciduous teeth and impacted permanent and supernumerary teeth

    Directory of Open Access Journals (Sweden)

    Mahalakshmi Ikkanur Puttaranganaik

    2014-01-01

    Full Text Available Cleidocranial dysplasia is a disease that occurs secondary to a dominant autosomal inheritance. There is no predilection for any genre or ethnic group. As there is a delay in the eruption and/or absence of permanent teeth, the patients usually report to a dental surgeon for replacement of the missing teeth. This condition is characterized by several cranial malformations and underdevelopment, absence of clavicles, and multiple impacted supernumerary and permanent teeth. The diagnosis of the condition is usually based on the presence of the above-mentioned main features and on clinical and familial evidence. Here we report a rare case of cleidocranial dysplasia in a male patient, having most of the characteristic features of this syndrome.

  1. Caries, Periodontal Disease, Supernumerary Teeth and Other Dental Disorders in Swedish Wild Boar (Sus scrofa).

    Science.gov (United States)

    Malmsten, A; Dalin, A-M; Pettersson, A

    2015-07-01

    Between January and December 2013, the dental and periodontal health of 99 Swedish wild boars (Sus scrofa) was investigated. Sampling occurred in conjunction with routine hunting at six large estates in the southern and middle parts of Sweden. All six of the estates use supplemental feeding. The weight of the animals, their sex and their dates of death were noted. Age was estimated using tooth eruption and tooth replacement patterns. The oral cavity was inspected and abnormalities were recorded on a dental chart modified for wild boars. The findings included supernumerary teeth, absence of teeth, mild class II malocclusion, severe tooth wear, periodontitis, calculus, caries, tooth fractures and the presence of enamel defects. Swedish wild boars suffer from different dental lesions and the impact of supplemental feeding on dental and periodontal health is still to be investigated.

  2. Removal of Supernumerary Teeth Utilizing a Computer-Aided Design/Computer-Aided Manufacturing Surgical Guide.

    Science.gov (United States)

    Jo, Chanwoo; Bae, Doohwan; Choi, Byungho; Kim, Jihun

    2017-05-01

    Supernumerary teeth need to be removed because they can cause various complications. Caution is needed because their removal can cause damage to permanent teeth or tooth germs in the local vicinity. Surgical guides have recently been used in maxillofacial surgery. Because surgical guides are designed through preoperative analysis by computer-aided design software and fabricated using a 3-dimensional printer applying computer-aided manufacturing technology, they increase the accuracy and predictability of surgery. This report describes 2 cases of removal of a mesiodens-1 from a child and 1 from an adolescent-using a surgical guide; these would have been difficult to remove with conventional surgical methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Kerr-Like Phantom Wormhole

    CERN Document Server

    Miranda, Galaxia; García, Nadiezhda Motelongo

    2013-01-01

    In this work we study a Kerr-like wormhole with phantom matter as source. It has three parameters: mass, angular momentum and scalar field charge. This wormhole has a naked ring singularity, other wise it is regular everywhere. The mean feature of this wormhole is that the mouth of the throat lie on a sphere of the same radius as the ring singularity an avoids any observer to see or to reach the singularity, it behaves like an anti-horizon. We analyse the geodesics of the wormhole and find that an observer can go through the geodesics without troubles, but the equator presents an infinity potential barrier which avoids to reach the throat. From an analysis of the Riemann tensor we obtain that the tidal forces permits the wormhole to be traversable for an observer like a human being.

  4. Galactosemia and phantom absence seizures

    Directory of Open Access Journals (Sweden)

    Zeynep Aydin-Özemir

    2014-01-01

    Full Text Available Generalized and focal seizures can rarely be seen in galactosemia patients, but absence seizures were not reported previously. An 18-year-old male was diagnosed as galactosemia at the age of 8 months. No family history of epilepsy was present. His absence seizures realized at the age of 9 years. Generalized 3-4 Hz spike-wave discharges were identified in his electroencephalography. Homozygous mutation at exon 6 c. 563A > G was identified. The electroencephalogram of his sibling was unremarkable. Our aim was to present the long-term follow-up of a patient diagnosed with galactosemia, who had phantom absence seizures and typical 3-4 Hz spike-wave discharges in his electroencephalogram to draw attention to this rare association.

  5. 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.

  6. Development of phantoms for spiral CT.

    Science.gov (United States)

    Goodenough, D J; Levy, J R; Kasales, C

    1998-01-01

    This paper reports on the development of a new phantom for spiral CT. The phantom meets the increased demands on phantom z-axis uniformity in order that objects from the CT slice, immediately above and below the CT slice of interest, do not contribute perturbing information to the reconstructed CT slice. The phantom depends on formulation of tissue-like materials that can be cast and produced in both geometric and anthropomorphic shapes with sufficient z-axis length to enable unperturbed CT slices of test objects of interest. These materials are then used to produce a series of test objects of CT image quality including low contrast samples that do not require volume averaging or mixing of solutions, and that can reflect sub-slice thickness test objects and supra-slice thickness test objects. The overall phantom and its individual test objects provides meaningful tests of spiral CT image quality including slice sensitivity, CT number linearity and tests of high and low contrast resolution. Schematic designs and actual CT scans are shown. The new spiral phantom appears to meet the increased demands of spiral CT on phantom design, particularly z-axis length, and requirements for low contrast resolution test objects.

  7. The reference phantoms: voxel vs polygon.

    Science.gov (United States)

    Kim, C H; Yeom, Y S; Nguyen, T T; Wang, Z J; Kim, H S; Han, M C; Lee, J K; Zankl, M; Petoussi-Henss, N; Bolch, W E; Lee, C; Chung, B S

    2016-06-01

    The International Commission on Radiological Protection (ICRP) reference male and female adult phantoms, described in Publication 110, are voxel phantoms based on whole-body computed tomography scans of a male and a female patient, respectively. The voxel in-plane resolution and the slice thickness, of the order of a few millimetres, are insufficient for proper segmentation of smaller tissues such as the lens of the eye, the skin, and the walls of some organs. The calculated doses for these tissues therefore present some limitations, particularly for weakly penetrating radiation. Similarly, the Publication 110 phantoms cannot represent 8-40-µm-thick target regions in respiratory or alimentary tract organs. Separate stylised models have been used to represent these tissues for calculation of the ICRP reference dose coefficients (DCs). ICRP Committee 2 recently initiated a research project, the ultimate goal of which is to convert the Publication 110 phantoms to a high-quality polygon-mesh (PM) format, including all source and target regions, even those of the 8-40-µm-thick alimentary and respiratory tract organs. It is expected that the converted phantoms would lead to the same or very similar DCs as the Publication 110 reference phantoms for penetrating radiation and, at the same time, provide more accurate DCs for weakly penetrating radiation and small tissues. Additionally, the reference phantoms in the PM format would be easily deformable and, as such, could serve as a starting point to create phantoms of various postures for use, for example, in accidental dose calculations. This paper will discuss the current progress of the phantom conversion project and its significance for ICRP DC calculations.

  8. 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.

  9. 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.

  10. Charged black holes in phantom cosmology

    Energy Technology Data Exchange (ETDEWEB)

    Jamil, Mubasher; Qadir, Asghar; Rashid, Muneer Ahmad [National University of Sciences and Technology, Center for Advanced Mathematics and Physics, Rawalpindi (Pakistan)

    2008-11-15

    In the classical relativistic regime, the accretion of phantom-like dark energy onto a stationary black hole reduces the mass of the black hole. We have investigated the accretion of phantom energy onto a stationary charged black hole and have determined the condition under which this accretion is possible. This condition restricts the mass-to-charge ratio in a narrow range. This condition also challenges the validity of the cosmic-censorship conjecture since a naked singularity is eventually produced due to accretion of phantom energy onto black hole. (orig.)

  11. Molecular cytogenetic characterization of a small, familial supernumerary ring chromosome 7 associated with mental retardation and an abnormal phenotype.

    Science.gov (United States)

    Tan-Sindhunata, G; Castedo, S; Leegte, B; Mulder, I; vd Veen, A Y; vd Hout, A H; Wiersma, T J; van Essen, A J

    2000-05-15

    A family is described in which a mother and two of her children were mosaic for a small supernumerary ring chromosome. As the origin of the ring chromosome could not be determined by routine cytogenetic studies, fluorescent in situ hybridization was performed, which indicated that the ring chromosome was derived from the pericentromeric region of chromosome 7. Further characterization with a YAC-probe showed the involvement of the proximal q-arm of chromosome 7. Both sibs had speech difficulties and were mildly mentally retarded whereas the mother's intelligence was at the lower end of the normal range. They all had an unusual face, characterized by a flat profile, short forehead, downslant of the palpebral fissures, high and broad nasal bridge, simply formed ears, and prognathia. This is the second report of a small supernumerary ring chromosome derived from the pericentromeric region of chromosome 7, and the described clinical phenotype differs from that delineated in the previous report.

  12. Autotransplantation of a Supernumerary Tooth to Replace a Misaligned Incisor with Abnormal Dimensions and Morphology: 2-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    R. Ebru Tirali

    2013-01-01

    Full Text Available Autotransplantation is a viable treatment option to restore esthetics and function impaired by abnormally shaped teeth when a suitable donors tooth is available. This paper describes the autotransplantation and 2-year follow-up of a supernumerary maxillary incisor as a replacement to a misaligned maxillary incisor with abnormal crown morphology and size. The supernumerary incisor was immediately autotransplanted into the extraction site of the large incisor and was stabilized with a bonded semirigid splint for 2 weeks. Fixed orthodontic therapy was initiated 3 months after autotransplantation. Ideal alignment of the incisors was accomplished after 6 months along with radiographic evidence of apical closure and osseous/periodontal regeneration. In autogenous tooth transplantation, a successful clinical outcome can be achieved if the cases are selected and treated properly.

  13. Sarjeev′s supernumerary tooth notation system: A universally compatible add-on to the Two-Digit system

    Directory of Open Access Journals (Sweden)

    Sarjeev Singh Yadav

    2013-01-01

    Full Text Available Aim: To give notation for quadrants, tooth position, and the type of supernumerary teeth for both permanent and deciduous dentition. Tooth numbering provides dentists with an essential shortcut in clinical record keeping. Materials and Methods: Three systems are favored worldwide: the Zsigmondy/Palmer system, the Universal system, and the Federation Dentaire Internationale (FDI Two-Digit system. Histories of all tooth-numbering methods were traced and the strengths and deficiencies of each system were reviewed. The FDI Two-Digit system is widely used throughout the world, except USA, and is the only method that makes the visual sense, cognitive sense, and computer sense. Conclusion: On review it was noticed that all tooth notation systems in vogue have a drawback as they do not provide any information or notations for supernumerary teeth such as paramolar, distomolar, mesiodens, and fused teeth.

  14. Sarjeev's supernumerary tooth notation system: a universally compatible add-on to the Two-Digit system.

    Science.gov (United States)

    Yadav, Sarjeev Singh; Sonkurla, Sapna

    2013-01-01

    To give notation for quadrants, tooth position, and the type of supernumerary teeth for both permanent and deciduous dentition. Tooth numbering provides dentists with an essential shortcut in clinical record keeping. Three systems are favored worldwide: the Zsigmondy/Palmer system, the Universal system, and the Federation Dentaire Internationale (FDI) Two-Digit system. Histories of all tooth-numbering methods were traced and the strengths and deficiencies of each system were reviewed. The FDI Two-Digit system is widely used throughout the world, except USA, and is the only method that makes the visual sense, cognitive sense, and computer sense. On review it was noticed that all tooth notation systems in vogue have a drawback as they do not provide any information or notations for supernumerary teeth such as paramolar, distomolar, mesiodens, and fused teeth.

  15. Management of fused supernumerary teeth in children using guided tissue regeneration: long-term follow up of 2 cases.

    Science.gov (United States)

    Olsen, Christopher B; Johnston, Timothy; Desai, Mala; Peake, Gregory G

    2002-01-01

    Surgical separation of supernumerary teeth fused to permanent incisor teethhas typically given rise to residual post surgical periodontal defects, induding loss of attachment and deep periodontal pocketing with persistent inflammation. Other complications include devitalisation of the retained tooth section, ankylosis, external and replacement resorption. A unique technique of using guided tissue regeneration has been successfully employed to promote periodontal healing, after 2 cases of surgical removal of a supernumerary tooth fused to a permanent maxillary lateral incisor tooth. In the first case, a 2-stage guided tissue regeneration technique was completed with a nonresorbable Gor-Tex membrane, and was followed up after 9 years. The second case was completed using a resorbable Vicryl membrane, in a single-stage guided tissue regenerative technique; and was followed up after 5 years.

  16. Pulsed radiofrequency of lumbar dorsal root ganglion for chronic postamputation phantom pain.

    Science.gov (United States)

    Imani, Farnad; Gharaei, Helen; Rezvani, Mehran

    2012-01-01

    Chronic pain following lower-limb amputation is now a well-known neuropathic, chronic-pain syndrome that usually presents as a combination of phantom and stump pain. Controlling these types of neuropathic pain is always complicated and challenging. If pharmacotherapy does not control the patient's pain, interventional procedures have to be taken. The aim of this study was to evaluate the efficacy of using pulsed radiofrequency (PRF) on the dorsal root ganglia at the L4 and L5 nerve roots to improve phantom pain. Two patients with phantom pain were selected for the study. After a positive response to segmental nerve blockade at the L4 and L5 nerve roots, PRF was performed on the L4 and L5 dorsal root ganglia. Global clinical improvement was good in one patient, with a 40% decrease in pain on the visual analogue scale (VAS) in 6 months, and moderate in the second patient, with a 30% decrease in pain scores in 4 months. PRF of the dorsal root ganglia at the L4 and L5 nerve roots may be an effective therapeutic option for patients with refractory phantom pain.

  17. Low grade mosaic for a complex supernumerary ring chromosome 18 in an adult patient with multiple congenital anomalies

    Directory of Open Access Journals (Sweden)

    Hoogeboom A Jeannette M

    2010-07-01

    Full Text Available Abstract Background Several cases have been reported of patients with a ring chromosome 18 replacing one of the normal chromosomes 18. Less common are patients with a supernumerary ring chromosomes 18. High resolution whole genome examination in patients with multiple congenital abnormalities might reveal cytogenetic abnormalities of an unexpected complexity. Results We report a 24 years old male patient with lower spinal anomalies, hypospadia, bifid scrotum, cryptorchism, anal atresia, kidney stones, urethra anomalies, radial dysplasia, and a hypoplastic thumb. Some of the anomalies overlap with the VACTERL association. Chromosome analysis of cultured peripheral blood lymphocytes revealed an additional ring chromosome in 13% of the metaphases. Both parents had a normal karyotype, demonstrating the de novo origin of this ring chromosome. FISH analysis using whole chromosome paints showed that the additional chromosomal material was derived from chromosome 18. Chromosome analysis of cultured fibroblasts revealed only one cell with the supernumerary ring chromosome in the 400 analyzed. To characterize the ring chromosome in more detail peripheral blood derived DNA was analyzed using SNP-arrays. The array results indicated a 5 Mb gain of the pericentromeric region of chromosome 18q10-q11.2. FISH analysis using BAC-probes located in the region indicated the presence of 6 signals on the r(18 chromosome. In addition, microsatellite analysis demonstrated that the unique supernumerary ring chromosome was paternally derived and both normal copies showed biparental disomy. Conclusions We report on an adult patient with multiple congenital abnormalities who had in 13% of his cells a unique supernumerary ring chromosome 18 that was composed of 6 copies of the 5 Mb gene rich region of 18q11.

  18. [Adequacy of amputation analgesia as a factor preventing the triggering of pain memory in the genesis of phantom pain syndrome].

    Science.gov (United States)

    Ovechkin, A M; Kukushkin, M L; Gnezdilov, A V; Reshetniak, V K

    1995-01-01

    Examinations of 72 patients with a history of amputation of the lower limb showed that preamputation pain may be transformed into phantom pain via "pain memory" mechanisms. This fact is confirmed by similarity of the verbal structure of preamputation pain and phantom pain syndrome, which are particularly expressed in the patients operated on under total anesthesia. At the same time, the share of patients considering phantom pain identical to preamputation pain is much lower among those operated on under prolonged perioperative epidural anesthesia, and no "pain memory" phenomena are observed in this group 6 months after surgery. Prolonged epidural anesthesia provides a pain-free period before surgery by disrupting the time relationship between nociceptive impulsation entry in the CNS structures and amputation, thus preventing fixation of 'pain experience' survived in the memory. The adequacy of intraoperative analgesia attained by prolonged epidural anesthesia plays the crucial role in prevention of realization of the "pain memory" effect.

  19. Hand-to-Face Remapping But No Differences in Temporal Discrimination Observed on the Intact Hand Following Unilateral Upper Limb Amputation

    Science.gov (United States)

    Collins, Kassondra L.; McKean, Danielle L.; Huff, Katherine; Tommerdahl, Mark; Favorov, Oleg Vyacheslavovich; Waters, Robert S.; Tsao, Jack W.

    2017-01-01

    Unilateral major limb amputation causes changes in sensory perception. Changes may occur within not only the residual limb but also the intact limb as well as the brain. We tested the hypothesis that limb amputation may result in the detection of hand sensation during stimulation of a non-limb-related body region. We further investigated the responses of unilateral upper limb amputees and individuals with all limbs intact to temporally based sensory tactile testing of the fingertips to test the hypothesis that changes in sensory perception also have an effect on the intact limb. Upper extremity amputees were assessed for the presence of referred sensations (RSs)—experiencing feelings in the missing limb when a different body region is stimulated, to determine changes within the brain that occur due to an amputation. Eight of 19 amputees (42.1%) experienced RS in the phantom limb with manual tactile mapping on various regions of the face. There was no correlation between whether someone had phantom sensations or phantom limb pain and where RS was found. Six of the amputees had either phantom sensation or pain in addition to RS induced by facial stimulation. Results from the tactile testing showed that there were no significant differences in the accuracy of participants in the temporal order judgment tasks (p = 0.702), whereby participants selected the digit that was tapped first by a tracking paradigm that resulted in correct answers leading to shorter interstimulus intervals (ISIs) and incorrect answers increasing the ISI. There were also no significant differences in timing perception, i.e., the threshold accuracy of the duration discrimination task (p = 0.727), in which participants tracked which of the two digits received a longer stimulus. We conclude that many, but not all, unilateral upper limb amputees experience phantom hand sensation and/or pain with stimulation of the face, suggesting that there could be postamputation changes in neuronal

  20. 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...

  1. Phantom cosmology without Big Rip singularity

    Energy Technology Data Exchange (ETDEWEB)

    Astashenok, Artyom V. [Baltic Federal University of I. Kant, Department of Theoretical Physics, 236041, 14, Nevsky st., Kaliningrad (Russian Federation); Nojiri, Shin' ichi, E-mail: nojiri@phys.nagoya-u.ac.jp [Department of Physics, Nagoya University, Nagoya 464-8602 (Japan); Kobayashi-Maskawa Institute for the Origin of Particles and the Universe, Nagoya University, Nagoya 464-8602 (Japan); Odintsov, Sergei D. [Department of Physics, Nagoya University, Nagoya 464-8602 (Japan); Institucio Catalana de Recerca i Estudis Avancats - ICREA and Institut de Ciencies de l' Espai (IEEC-CSIC), Campus UAB, Facultat de Ciencies, Torre C5-Par-2a pl, E-08193 Bellaterra (Barcelona) (Spain); Tomsk State Pedagogical University, Tomsk (Russian Federation); Yurov, Artyom V. [Baltic Federal University of I. Kant, Department of Theoretical Physics, 236041, 14, Nevsky st., Kaliningrad (Russian Federation)

    2012-03-23

    We construct phantom energy models with the equation of state parameter w which is less than -1, w<-1, but finite-time future singularity does not occur. Such models can be divided into two classes: (i) energy density increases with time ('phantom energy' without 'Big Rip' singularity) and (ii) energy density tends to constant value with time ('cosmological constant' with asymptotically de Sitter evolution). The disintegration of bound structure is confirmed in Little Rip cosmology. Surprisingly, we find that such disintegration (on example of Sun-Earth system) may occur even in asymptotically de Sitter phantom universe consistent with observational data. We also demonstrate that non-singular phantom models admit wormhole solutions as well as possibility of Big Trip via wormholes.

  2. Custom molded thermal MRg-FUS phantom

    Science.gov (United States)

    Eames, Matthew D. C.; Snell, John W.; Hananel, Arik; Kassell, Neal F.

    2012-11-01

    This article describes a method for creating custom-molded thermal phantoms for use with MR-guided focused ultrasound systems. The method is defined here for intracranial applications, though it may be modified for other anatomical targets.

  3. Development of realistic physical breast phantoms matched to virtual breast phantoms based on human subject data.

    Science.gov (United States)

    Kiarashi, Nooshin; Nolte, Adam C; Sturgeon, Gregory M; Segars, William P; Ghate, Sujata V; Nolte, Loren W; Samei, Ehsan; Lo, Joseph Y

    2015-07-01

    Physical phantoms are essential for the development, optimization, and evaluation of x-ray breast imaging systems. Recognizing the major effect of anatomy on image quality and clinical performance, such phantoms should ideally reflect the three-dimensional structure of the human breast. Currently, there is no commercially available three-dimensional physical breast phantom that is anthropomorphic. The authors present the development of a new suite of physical breast phantoms based on human data. The phantoms were designed to match the extended cardiac-torso virtual breast phantoms that were based on dedicated breast computed tomography images of human subjects. The phantoms were fabricated by high-resolution multimaterial additive manufacturing (3D printing) technology. The glandular equivalency of the photopolymer materials was measured relative to breast tissue-equivalent plastic materials. Based on the current state-of-the-art in the technology and available materials, two variations were fabricated. The first was a dual-material phantom, the Doublet. Fibroglandular tissue and skin were represented by the most radiographically dense material available; adipose tissue was represented by the least radiographically dense material. The second variation, the Singlet, was fabricated with a single material to represent fibroglandular tissue and skin. It was subsequently filled with adipose-equivalent materials including oil, beeswax, and permanent urethane-based polymer. Simulated microcalcification clusters were further included in the phantoms via crushed eggshells. The phantoms were imaged and characterized visually and quantitatively. The mammographic projections and tomosynthesis reconstructed images of the fabricated phantoms yielded realistic breast background. The mammograms of the phantoms demonstrated close correlation with simulated mammographic projection images of the corresponding virtual phantoms. Furthermore, power-law descriptions of the phantom images

  4. Development of realistic physical breast phantoms matched to virtual breast phantoms based on human subject data

    Energy Technology Data Exchange (ETDEWEB)

    Kiarashi, Nooshin [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710 and Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27708 (United States); Nolte, Adam C. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710 and Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Sturgeon, Gregory M.; Ghate, Sujata V. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710 (United States); Segars, William P. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710 and Medical Physics Graduate Program, Duke University, Durham, North Carolina 27708 (United States); Nolte, Loren W. [Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27708 and Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Samei, Ehsan [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710 (United States); Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27708 (United States); Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27708 (United States); Department of Physics, Duke University, Durham, North Carolina 27708 (United States); and others

    2015-07-15

    Purpose: Physical phantoms are essential for the development, optimization, and evaluation of x-ray breast imaging systems. Recognizing the major effect of anatomy on image quality and clinical performance, such phantoms should ideally reflect the three-dimensional structure of the human breast. Currently, there is no commercially available three-dimensional physical breast phantom that is anthropomorphic. The authors present the development of a new suite of physical breast phantoms based on human data. Methods: The phantoms were designed to match the extended cardiac-torso virtual breast phantoms that were based on dedicated breast computed tomography images of human subjects. The phantoms were fabricated by high-resolution multimaterial additive manufacturing (3D printing) technology. The glandular equivalency of the photopolymer materials was measured relative to breast tissue-equivalent plastic materials. Based on the current state-of-the-art in the technology and available materials, two variations were fabricated. The first was a dual-material phantom, the Doublet. Fibroglandular tissue and skin were represented by the most radiographically dense material available; adipose tissue was represented by the least radiographically dense material. The second variation, the Singlet, was fabricated with a single material to represent fibroglandular tissue and skin. It was subsequently filled with adipose-equivalent materials including oil, beeswax, and permanent urethane-based polymer. Simulated microcalcification clusters were further included in the phantoms via crushed eggshells. The phantoms were imaged and characterized visually and quantitatively. Results: The mammographic projections and tomosynthesis reconstructed images of the fabricated phantoms yielded realistic breast background. The mammograms of the phantoms demonstrated close correlation with simulated mammographic projection images of the corresponding virtual phantoms. Furthermore, power

  5. Conversion of ICRP male reference phantom to polygon-surface phantom

    Science.gov (United States)

    Yeom, Yeon Soo; Han, Min Cheol; Kim, Chan Hyeong; Jeong, Jong Hwi

    2013-10-01

    The International Commission on Radiological Protection (ICRP) reference phantoms, developed based on computed tomography images of human bodies, provide much more realism of human anatomy than the previously used MIRD5 (Medical Internal Radiation Dose) mathematical phantoms. It has been, however, realized that the ICRP reference phantoms have some critical limitations showing a considerable amount of holes for the skin and wall organs mainly due to the nature of voxels of which the phantoms are made, especially due to their low voxel resolutions. To address this problem, we are planning to develop the polygon-surface version of ICRP reference phantoms by directly converting the ICRP reference phantoms (voxel phantoms) to polygon-surface phantoms. The objective of this preliminary study is to see if it is indeed possible to construct the high-quality polygon-surface phantoms based on the ICRP reference phantoms maintaining identical organ morphology and also to identify any potential issues, and technologies to address these issues, in advance. For this purpose, in the present study, the ICRP reference male phantom was roughly converted to a polygon-surface phantom. Then, the constructed phantom was implemented in Geant4, Monte Carlo particle transport code, for dose calculations, and the calculated dose values were compared with those of the original ICRP reference phantom to see how much the calculated dose values are sensitive to the accuracy of the conversion process. The results of the present study show that it is certainly possible to convert the ICRP reference phantoms to surface phantoms with enough accuracy. In spite of using relatively less resources (<2 man-months), we were able to construct the polygon-surface phantom with the organ masses perfectly matching the ICRP reference values. The analysis of the calculated dose values also implies that the dose values are indeed not very sensitive to the detailed morphology of the organ models in the phantom

  6. Paul Wittgenstein's right arm and his phantom: the saga of a famous concert pianist and his amputation.

    Science.gov (United States)

    Boller, François; Bogousslavsky, Julien

    2015-01-01

    Reports of postamputation pain and problems linked to phantom limbs have increased in recent years, particularly in relation to war-related amputations. These problems are still poorly understood and are considered rather mysterious, and they are difficult to treat. In addition, they may shed light on brain physiology and neuropsychology. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Several artists have suffered from postamputation complications and this has influenced not only their personal life but also their artistic work. Paul Wittgenstein (1887-1961), a pianist whose right arm was amputated during the First World War, became a famous left-handed concert performer. His case provides insight into Post-World War I musical and political history. More specifically, the impact on the artistic life of this pianist illustrates various postamputation complications, such as phantom limb, stump pain, and especially moving phantom. The phantom movements of his right hand helped him develop the dexterity of his left hand. Wittgenstein played piano works that were written especially for him (the most famous being Ravel's Concerto for the Left Hand) and composed some of his own. Additionally, several famous composers had previously written for the left hand.

  7. Artificial redirection of sensation from prosthetic fingers to the phantom hand map on transradial amputees: vibrotactile versus mechanotactile sensory feedback.

    Science.gov (United States)

    Antfolk, Christian; D'Alonzo, Marco; Controzzi, Marco; Lundborg, Göran; Rosén, Birgitta; Sebelius, Fredrik; Cipriani, Christian

    2013-01-01

    This work assesses the ability of transradial amputees to discriminate multi-site tactile stimuli in sensory discrimination tasks. It compares different sensory feedback modalities using an artificial hand prosthesis in: 1) a modality matched paradigm where pressure recorded on the five fingertips of the hand was fed back as pressure stimulation on five target points on the residual limb; and 2) a modality mismatched paradigm where the pressures were transformed into mechanical vibrations and fed back. Eight transradial amputees took part in the study and were divided in two groups based on the integrity of their phantom map; group A had a complete phantom map on the residual limb whereas group B had an incomplete or nonexisting map. The ability in localizing stimuli was compared with that of 10 healthy subjects using the vibration feedback and 11 healthy subjects using the pressure feedback (in a previous study), on their forearms, in similar experiments. Results demonstrate that pressure stimulation surpassed vibrotactile stimulation in multi-site sensory feedback discrimination. Furthermore, we demonstrate that subjects with a detailed phantom map had the best discrimination performance and even surpassed healthy participants for both feedback paradigms whereas group B had the worst performance overall. Finally, we show that placement of feedback devices on a complete phantom map improves multi-site sensory feedback discrimination, independently of the feedback modality.

  8. An unusual cause of S1 radicular pain presenting as early phantom pain in a transfemoral amputee: a case report.

    Science.gov (United States)

    Smuck, Matthew; Christensen, Sara; Lee, Stan S; Sagher, Oren

    2008-01-01

    Recent epidemiologic studies have shown back pain to be a significant cause of pain in lower-limb amputees, but only a handful of cases have reported sciatica in amputees. The symptoms are usually described as a phantom pain or neuropathic pain in the residual limb that is often refractory to conventional treatments. These symptoms typically occur with back pain and are distinct from the patient's usual symptoms. Interestingly, back pain is not a universal finding. We present a patient with presumed phantom limb pain subsequently discovered to be caused by an S1 radiculopathy. This patient's supposed phantom pain persisted despite multiple medication trials. Initial work-up revealed a sciatic neuroma at the stump. Treatments targeting this neuroma were unsuccessful. Further evaluation found that a sacroiliac joint screw placed to stabilize a pelvic fracture had intruded into the S1 neuroforamen. A diagnostic S1 nerve block temporarily relieved the patient's pain, and the screw was removed. Pain persisted and a spinal cord stimulator was placed resulting in improvement of his pain. Because conventional diagnostic tests are limited, including physical exam and electromyography, a fluoroscopically guided selective spinal nerve block proved to be a useful diagnostic tool in this patient.

  9. Phantom headache: pain-memory-emotion hypothesis for chronic daily headache?

    OpenAIRE

    Prakash, Sanjay; Golwala, Purva

    2011-01-01

    The neurobiology of chronic pain, including chronic daily headache (CDH) is not completely understood. “Pain memory” hypothesis is one of the mechanisms for phantom limb pain. We reviewed the literature to delineate a relation of “pain memory” for the development of CDH. There is a direct relation of pain to memory. Patients with poor memory have less chance to develop “pain memory”, hence less possibility to develop chronic pain. Progressive memory impairment may lead to decline in headache ...

  10. Pulsed Radiofrequency of Lumbar Dorsal Root Ganglion for Chronic Postamputation Phantom Pain

    OpenAIRE

    Imani, Farnad; Gharaei, Helen; Rezvani, Mehran

    2012-01-01

    Chronic pain following lower-limb amputation is now a well-known neuropathic, chronic-pain syndrome that usually presents as a combination of phantom and stump pain. Controlling these types of neuropathic pain is always complicated and challenging. If pharmacotherapy does not control the patient’s pain, interventional procedures have to be taken. The aim of this study was to evaluate the efficacy of using pulsed radiofrequency (PRF) on the dorsal root ganglia at the L4 and L5 nerve roots to i...

  11. Beyond the big five: the Dark Triad and the supernumerary personality inventory.

    Science.gov (United States)

    Veselka, Livia; Schermer, Julie Aitken; Vernon, Philip A

    2011-04-01

    The Dark Triad of personality, comprising Machiavellianism, narcissism, and psychopathy, was investigated in relation to the Supernumerary Personality Inventory (SPI) traits, because both sets of variables are predominantly distinct from the Big Five model of personality. Correlational and principal factor analyses were conducted to assess the relations between the Dark Triad and SPI traits. Multivariate behavioral genetic model-fitting analyses were also conducted to determine the correlated genetic and/or environmental underpinnings of the observed phenotypic correlations. Participants were 358 monozygotic and 98 same-sex dizygotic adult twin pairs from North America. As predicted, results revealed significant correlations between the Dark Triad and most SPI traits, and these correlations were primarily attributable to common genetic and non-shared environmental factors, except in the case of Machiavellianism, where shared environmental effects emerged. Three correlated factors were extracted during joint factor analysis of the Dark Triad and SPI traits, as well as a heritable general factor of personality - results that clarified the structure of the Dark Triad construct. It is concluded that the Dark Triad represents an exploitative and antisocial construct that extends beyond the Big Five model and shares a theoretical space with the SPI traits.

  12. Origin and molecular organization of supernumerary chromosomes of Prochilodus lineatus (characiformes, prochilodontidae) obtained by DNA probes.

    Science.gov (United States)

    Voltolin, Tatiana Aparecida; Laudicina, Alejandro; Senhorini, José Augusto; Bortolozzi, Jehud; Oliveira, Cláudio; Foresti, Fausto; Porto-Foresti, Fábio

    2010-12-01

    In Prochilodus lineatus B-chromosomes are visualized as reduced size extra elements identified as microchromosomes and are variable in morphology and number. We describe the specific total probe (B-chromosome probe) in P. lineatus obtained by chromosome microdissection and a whole genomic probe (genomic probe) from an individual without B-chromosome. The specific B-chromosome was scraped and processed to obtain DNA with amplification by DOP-PCR, and so did the genomic probe DNA. Fluorescence in situ hybridization using the B-chromosome probe labeled with dUTP-Tetramethyl-rhodamine and the genomic probe labeled with digoxigenin-FITC permitted to establish that in this species supernumerary chromosomes with varying number and morphology had different structure of chromatin when compared to that of the regular chromosomes or A complement, since only these extra elements were labeled in the metaphases. The present findings suggest that modifications in the chromatin structure of B-chromosomes to differentiate them from the A chromosomes could occur along their dispersion in the individuals of the population.

  13. Array comparative genomic hybridization analysis of small supernumerary marker chromosomes in human infertility.

    Science.gov (United States)

    Guediche, N; Tosca, L; Kara Terki, A; Bas, C; Lecerf, L; Young, J; Briand-Suleau, A; Tou, B; Bouligand, J; Brisset, S; Misrahi, M; Guiochon-Mantel, A; Goossens, M; Tachdjian, G

    2012-01-01

    Small supernumerary marker chromosomes (sSMC) are structurally abnormal chromosomes that cannot be unambiguously identified by conventional banding cytogenetics. This study describes four patients with sSMC in relation with infertility. Patient 1 had primary infertility. His brother, fertile, carried the same sSMC (patient 2). Patient 3 presented polycystic ovary syndrome and patient 4 primary ovarian insufficiency. Cytogenetic studies, array comparative genomic hybridization (CGH) and sperm analyses were compared with cases previously reported. sSMC corresponded to the 15q11.2 region (patients 1 and 2), the centromeric chromosome 15 region (patient 3) and the 21p11.2 region (patient 4). Array CGH showed 3.6-Mb gain for patients 1 and 2 and 0.266-Mb gain for patient 4. Sperm fluorescent in-situ hybridization analyses found ratios of 0.37 and 0.30 of sperm nuclei with sSMC(15) for patients 1 and 2, respectively (P < 0.001). An increase of sperm nuclei with disomy X, Y and 18 was noted for patient 1 compared with control and patient 2 (P < 0.001). Among the genes mapped in the unbalanced chromosomal regions, POTE B and BAGE are related to the testis and ovary, respectively. The implication of sSMC in infertility could be due to duplication, but also to mechanical effects perturbing meiosis.

  14. A clinical, cytogenetic, FISH and molecular study of supernumerary marker 15 chromosomes

    Energy Technology Data Exchange (ETDEWEB)

    Dennis, N.R. [Princess Anne Hospital, Southampton (United Kingdom); Crolla, J.A.; Harvey, J.F. [Salisbury District Hospital (United Kingdom)

    1994-09-01

    We studied 17 patients with supernumerary marker chromosomes shown by fluorescent in situ hybridization (FISH) with the 15-centromere specific probe pTRA-25 to be 15-derived. Genetic constitution of the marker chromosomes was investigated using FISH, Southern blot analysis and PCR for proximal and distal loci on 15q as well as conventional cytogenetics. Eight of the 17 patients were mentally retarded. Six of the eight carried a de novo marker 15 containing one or two doses of loci known to be in or near the Prader-Willi/Angelman (PWS/AS) region, whereas none of the nine non-retarded patients had duplications of this region, and only two of the eight whose parents were available had a de novo marker. None of the mentally retarded patients had PWS or AS. In two retarded patients (one de novo, one familial) there was no duplication of the PWS/AS region. Uniparental disomy affecting the normal 15 homologs was excluded in 10 of the patients, including all eight with mental retardation.

  15. Zika virus causes supernumerary foci with centriolar proteins and impaired spindle positioning

    Science.gov (United States)

    Wolf, Benita; Diop, Fodé; Ferraris, Pauline; Wichit, Sineewanlaya; Busso, Coralie; Missé, Dorothée

    2017-01-01

    Zika virus (ZIKV) causes congenital microcephaly. Although ZIKV can impair cell cycle progression and provoke apoptosis, which probably contributes to disease aetiology through depletion of neural progenitor cells, additional cellular mechanisms may be important. Here, we investigated whether ZIKV infection alters centrosome number and spindle positioning, because such defects are thought to be at the root of inherited primary autosomal recessive microcephaly (MCPH). In addition to HeLa cells, in which centrosome number and spindle positioning can be well monitored, we analysed retinal epithelial cells (RPE-1), as well as brain-derived microglial (CHME-5) and neural progenitor (ReN) cells, using immunofluorescence. We established that ZIKV infection leads to supernumerary foci containing centriolar proteins that in some cases drive multipolar spindle assembly, as well as spindle positioning defects in HeLa, RPE-1 and CHME-5 cells, but not in ReN cells. We uncovered similar phenotypes in HeLa cells upon infection with dengue virus (DENV-2), another flavivirus that does not target brain cells and does not cause microcephaly. We conclude that infection with Flaviviridae can increase centrosome numbers and impair spindle positioning, thus potentially contributing to microcephaly in the case of Zika. PMID:28100662

  16. Clinical impact of somatic mosaicism in cases with small supernumerary marker chromosomes.

    Science.gov (United States)

    Liehr, T; Klein, E; Mrasek, K; Kosyakova, N; Guilherme, R S; Aust, N; Venner, C; Weise, A; Hamid, A B

    2013-01-01

    Somatic mosaicism is present in slightly more than 50% of small supernumerary marker chromosome (sSMC) carriers. Interestingly, non-acrocentric derived sSMC show mosaicism much more frequently than acrocentric ones. sSMC can be present in different mosaic rates, which may go below 5% of the studied cells. Also cryptic mosaicism can be present and mosaics may be differently expressed in different tissues of the body. Even though in the overwhelming majority of the cases somatic sSMC mosaicism has no direct clinical effect, there are also cases with altered clinical outcomes due to mosaicism. Also clinically important is the fact that a de novo sSMC, even present in mosaic, may be a hint of uniparental disomy (UPD). As it is under discussion to possibly replace standard karyotyping by methods like array-CGH, the impracticality of the latter to detect low-level sSMC mosaics and/or UPD has to be considered as well. Overall, sSMC mosaicism has to be studied carefully in each individual case, as it can be extremely informative and of importance, especially for prenatal genetic counseling.

  17. Three Supernumerary Marker Chromosomes in a Patient with Developmental Delay, Mental Retardation, and Dysmorphic Features

    Directory of Open Access Journals (Sweden)

    Jie Hu

    2011-01-01

    Full Text Available We characterized three supernumerary marker chromosomes (SMCs simultaneously present in a 2-year- and 10-month-old male patient with mental retardation and dysmorphic features. Peripheral blood chromosome analysis revealed two to three SMCs in 25/26 cells analyzed. The remaining one cell had one SMC. Microarray comparative genomic hybridization (aCGH showed mosaicism for gains of 5q35.3, 15q11.2q13.3, and 18p11.21q11.1 regions. All three gains contain multiple OMIM genes. FISH studies indicated that one of the SMCs is a dicentric ring 15 with two copies of the 15q11.2q13.3 region including SNRPN/UBE3A and two copies of the 5q35.3 region. One of the der(18s contains the 18 centromere and 18p11.2 regions, while the other der(18 has a signal for the 18 centromere only. The phenotype of the patient is compared with that of patients with tetrasomy 15q11.2q13.3, trisomy 5q35.3, and trisomy 18p11.2. Our study demonstrates that aCGH and FISH analyses are powerful tools, which complement the conventional cytogenetic analysis for the identification of SMCs.

  18. Multiple, supernumerary retained teeth in the course of cleido-cranial dysplasia. A case report.

    Science.gov (United States)

    Lewandowski, Bogumił; Martula-Gala, Katarzyna; Brodowski, Robert; Zych, Barbara

    2015-01-01

    Cleido-cranial dysplasia, often referred to as Scheuthauer-Marie-Sainton syndrome, is an autosomal dominant disorder of the musculo-skeletal system. Patients with cleido-cranial dysplasia are characterized by short stature, frequent varus or valgus hip, kyphoscoliosis, underdevelopment of the scapulas and the sternum, incorrect number of ribs. The most characteristic feature is unilateral or bilateral, partial or total underdevelopment of clavicles. Mental development is not affected in this syndrome. Malocclusion, occlusal irregularities, multiple supernumerary teeth, impacted teeth, and persistent milk teeth are found in the stomatognathic system. Teeth often have abnormal anatomy. Gothic palate, cleft hard and soft palate are diagnosed. The aim of this paper is to present a case of a 12-year-old boy diagnosed with irregularities in the masticatory system involving an additional number of retained teeth. The boy was referred by an orthodontist for surgical and orthodontic team therapy. The case presented confirms the observations of other authors that only the multi-specialty collaboration of a pediatrician, a geneticist, an orthopedist, an orthodontist, a maxillofacial surgeon, an implant prosthetic surgeon and a physiotherapist can provide proper diagnosis and treatment.

  19. Human ring chromosomes and small supernumerary marker chromosomes-do they have telomeres?

    Science.gov (United States)

    Guilherme, Roberta Santos; Klein, Elisabeth; Venner, Claudia; Hamid, Ahmed B; Bhatt, Samarth; Melaragno, Maria Isabel; Volleth, Marianne; Polityko, Anna; Kulpanovich, Anna; Kosyakova, Nadezda; Liehr, Thomas

    2012-10-01

    Ring chromosomes and small supernumerary marker chromosomes (sSMC) are enigmatic types of derivative chromosomes, in which the telomeres are thought to play a crucial role in their formation and stabilization. Considering that there are only a few studies that evaluate the presence of telomeric sequences in ring chromosomes and on sSMC, here, we analyzed 14 ring chromosomes and 29 sSMC for the presence of telomeric sequences through fluorescence in situ hybridization (FISH). The results showed that ring chromosomes can actually fall into two groups: the ones with or without telomeres. Additionally, telomeric signals were detectable at both ends of centric and neocentric sSMC with inverted duplication shape, as well as in complex sSMC. Apart from that, generally both ring- and centric minute-shaped sSMC did not present telomeric sequences neither detectable by FISH nor by a second protein-directed immunohistochemical approach. However, the fact that telomeres are absent does not automatically mean that the sSMC has a ring shape, as often deduced in the previous literature. Overall, the results obtained by FISH studies directed against telomeres need to be checked carefully by other approaches.

  20. Clinical management of a fused mandibular lateral incisor with supernumerary tooth: A case report

    Directory of Open Access Journals (Sweden)

    Seda Aydemir

    2016-01-01

    Full Text Available The purpose of this report is to present a rare case of a fused mandibular lateral incisor with supernumerary tooth with a follow-up for 18-months. A 35-year-old female patient was referred to our clinic with an extraoral sinus tract in the chin. The intraoral diagnosis revealed the fusion of her mandibular lateral incisors. Vitality pulp tests were negative for mandibular right central and lateral incisors. Radiographic examinations showed a fused tooth with two separate pulp chambers, two distinct roots, and two separate root canals. There were also periapical lesion of fused teeth and mandibular right central incisor, so endodontic treatment was carried out the related teeth. Radiographic examination revealed a complete healing of the lesion postoperatively at the end of 18-months. This paper reports the successful endodontic and restorative treatment of unilateral fused incisors. Because of the abnormal morphology of the crown and the complexity of the root canal system in fused teeth, treatment protocols require special attention.

  1. Unusual small supernumerary marker chromosome (sSMC) 9 in a Klinefelter patient.

    Science.gov (United States)

    Liehr, T; Mrasek, K; Starke, H; Claussen, U; Schreiber, G

    2005-01-01

    Small supernumerary marker chromosomes (sSMC) are small additional chromosomes characterizable for their origin only by molecular cytogenetic approaches. sSMC have been reported previously in four types of syndromes associated with chromosomal imbalances: in approximately 150 cases with Turner syndrome, 26 cases with Down syndrome and only one case each with Klinefelter syndrome and "Triple-X"-syndrome. Here we report the second case with an sSMC detected in addition to a Klinefelter karyotype. Molecular cytogenetics applying centromere-specific multicolor FISH (cenM-FISH) and a specific subcentromere-specific (subcenM-FISH) probe set characterized the sSMC as a dic(9)(:p12-->q11.1::q11.1--> p11.1:). The reported patient was described with hypogonadism, gynaecomastia plus a bronchial carcinoma. The patient's clinical features are discussed in connection with other Klinefelter cases and possible consequences of presence of the sSMC(9). Furthermore, a suggestion is made for the mode of sSMC-formation in this case.

  2. Supernumerary marker chromosomes derived from chromosome 6: cytogenetic, molecular cytogenetic, and array CGH characterization.

    Science.gov (United States)

    Huang, Bing; Pearle, Phyllis; Rauen, Katherine A; Cotter, Philip D

    2012-07-01

    Supernumerary marker chromosomes (SMC) are relatively common in prenatal diagnosis. As the clinical outcomes vary greatly, a better understanding of the karyotype-phenotype correlation for different SMCs will be important for genetic counseling. We present two cases of prenatally detected de novo, small SMCs. The markers were present in 80% of amniocyte colonies in Case 1 and 38% of the colonies in Case 2. The SMCs were determined to be derived from chromosome 6 during postnatal confirmation studies. Although the sizes and the chromosomal origin of the SMCs in these two cases appeared to be similar, the clinical outcomes varied. The clinical manifestations observed in Case 1 included small for gestational age, feeding difficulty at birth, hydronephrosis, deviated septum and dysmorphic features, while the phenotype is apparently normal in Case 2. Array comparative genomic hybridization (CGH) was performed and showed increase in dosage for approximately 26 Mb of genetic material from the proximal short and long arms of chromosome 6 in Case 1. Results of array CGH were uninformative in Case 2, either due to mosaicism or lack of detectable euchromatin. The difference in the clinical presentation in these two patients may have resulted from the difference in the actual gene contents of the marker chromosomes and/or the differential distribution of the mosaicism.

  3. Characteristics and sequelae of erupted supernumerary teeth: A study of 218 cases among Sri Lankan children.

    Science.gov (United States)

    Herath, Chandra; Jayawardena, Chantha; Nagarathne, Nandani; Perera, Kanthi

    2016-12-19

    In the present study, we investigated the characteristics and sequelae of erupted supernumerary teeth (ST) in a sample of Sri Lankan children. Data were recorded from patients' clinical records, radiographs, models, and extracted teeth. The sample consisted of 239 ST from 218 patients. The mean age of the sample was 9.08 ± 2.47 years. The male-to-female ratio was 2.8:1. The majority (42.66%) of patients with ST were in aged 8-10 years. Many (94.94%) of the ST were located in the premaxilla (incisor), followed by the canine (4.22%), premolar (0.42%), and molar (0.42%) regions. The most common shape of ST teeth was conical. Malocclusion (59.83%) was the major problem associated with ST, and the clinical impact was highest on the 8-10-year age group. A strong association was observed between patients' age and clinical impact to the dentition (χ(2) =42.09, P=.000). Because the majority of ST can lead to malocclusion, especially in mixed dentition, awareness, early detection, and timely clinical intervention of ST are recommended. © 2016 John Wiley & Sons Australia, Ltd.

  4. Clinical management of a fused mandibular lateral incisor with supernumerary tooth: A case report

    Science.gov (United States)

    Aydemir, Seda; Ozel, Emre; Arukaslan, Goze; Tekce, Neslihan

    2016-01-01

    The purpose of this report is to present a rare case of a fused mandibular lateral incisor with supernumerary tooth with a follow-up for 18-months. A 35-year-old female patient was referred to our clinic with an extraoral sinus tract in the chin. The intraoral diagnosis revealed the fusion of her mandibular lateral incisors. Vitality pulp tests were negative for mandibular right central and lateral incisors. Radiographic examinations showed a fused tooth with two separate pulp chambers, two distinct roots, and two separate root canals. There were also periapical lesion of fused teeth and mandibular right central incisor, so endodontic treatment was carried out the related teeth. Radiographic examination revealed a complete healing of the lesion postoperatively at the end of 18-months. This paper reports the successful endodontic and restorative treatment of unilateral fused incisors. Because of the abnormal morphology of the crown and the complexity of the root canal system in fused teeth, treatment protocols require special attention. PMID:26962321

  5. Unexpected structural complexity of supernumerary marker chromosomes characterized by microarray comparative genomic hybridization

    Directory of Open Access Journals (Sweden)

    Hing Anne V

    2008-04-01

    Full Text Available Abstract Background Supernumerary marker chromosomes (SMCs are structurally abnormal extra chromosomes that cannot be unambiguously identified by conventional banding techniques. In the past, SMCs have been characterized using a variety of different molecular cytogenetic techniques. Although these techniques can sometimes identify the chromosome of origin of SMCs, they are cumbersome to perform and are not available in many clinical cytogenetic laboratories. Furthermore, they cannot precisely determine the region or breakpoints of the chromosome(s involved. In this study, we describe four patients who possess one or more SMCs (a total of eight SMCs in all four patients that were characterized by microarray comparative genomic hybridization (array CGH. Results In at least one SMC from all four patients, array CGH uncovered unexpected complexity, in the form of complex rearrangements, that could have gone undetected using other molecular cytogenetic techniques. Although array CGH accurately defined the chromosome content of all but two minute SMCs, fluorescence in situ hybridization was necessary to determine the structure of the markers. Conclusion The increasing use of array CGH in clinical cytogenetic laboratories will provide an efficient method for more comprehensive characterization of SMCs. Improved SMC characterization, facilitated by array CGH, will allow for more accurate SMC/phenotype correlation.

  6. 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.

  7. The pattern of a specimen of Pycnogonum litorale (Arthropoda, Pycnogonida) with a supernumerary leg can be explained with the "boundary model" of appendage formation

    Science.gov (United States)

    Scholtz, Gerhard; Brenneis, Georg

    2016-02-01

    A malformed adult female specimen of Pycnogonum litorale (Pycnogonida) with a supernumerary leg in the right body half is described concerning external and internal structures. The specimen was maintained in our laboratory culture after an injury in the right trunk region during a late postembryonic stage. The supernumerary leg is located between the second and third walking legs. The lateral processes connecting to these walking legs are fused to one large structure. Likewise, the coxae 1 of the second and third walking legs and of the supernumerary leg are fused to different degrees. The supernumerary leg is a complete walking leg with mirror image symmetry as evidenced by the position of joints and muscles. It is slightly smaller than the normal legs, but internally, it contains a branch of the ovary and a gut diverticulum as the other legs. The causes for this malformation pattern found in the Pycnogonum individual are reconstructed in the light of extirpation experiments in insects, which led to supernumerary mirror image legs, and the "boundary model" for appendage differentiation.

  8. Adjustable fetal phantom for pulse oximetry

    Science.gov (United States)

    Stubán, Norbert; Niwayama, Masatsugu

    2009-05-01

    As the measuring head of a fetal pulse oximeter must be attached to the head of the fetus inside the mother's uterus during labor, testing, and developing of fetal pulse oximeters in real environment have several difficulties. A fetal phantom could enable evaluation of pulse oximeters in a simulated environment without the restrictions and difficultness of medical experiments in the labor room. Based on anatomic data we developed an adjustable fetal head phantom with three different tissue layers and artificial arteries. The phantom consisted of two arteries with an inner diameter of 0.2 and 0.4 mm. An electronically controlled pump produced pulse waves in the arteries. With the phantom we investigated the sensitivity of a custom-designed wireless pulse oximeter at different pulsation intensity and artery diameters. The results showed that the oximeter was capable of identifying 4% and 2% changes in diameter between the diastolic and systolic point in arteries of over 0.2 and 0.4 mm inner diameter, respectively. As the structure of the phantom is based on reported anatomic values, the results predict that the investigated custom-designed wireless pulse oximeter has sufficient sensitivity to detect the pulse waves and to calculate the R rate on the fetal head.

  9. An MRI phantom using carrageenan gel

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Hirokazu; Kuroda, Masahiro; Yoshimura, Koichi; Kawasaki, Shoji; Yamamoto, Naotake; Tanaka, Akio; Hiraki, Yoshio [Okayama Univ. (Japan). School of Medicine; Uchida, Nobue; Sugimura, Kazuro

    2000-12-01

    We have developed a new solid type carrageenan gel phantom. The ingredients of the new gel are carrageenan, manganese chloride, sodium chloride, sodium azide, and water. The gel phantom has sufficient strength to form a torso without the use of a reinforcing agent. A phantom of a desired shape can be created by pouring a hot solution of carrageenan into a mold. The phantom can then be cut easily with a knife and trimmed into the desired shape. The recommended concentrations of the ingredients are; 5 wt% carrageenan, 0.2 mM MnCl{sub 2}, 0.19 wt% NaCl, 0.1 wt% NaN{sub 3}, with the remainder being water. T{sub 2} and T{sub 1} of this phantom at 1.5 T are 84.9 ms and 429 ms respectively. The conductivity and relative dielectric constant at 63.8 MHz are 0.769 S/m and 81.4 respectively. (author)

  10. Phantom evolving wormholes with big rip singularities

    CERN Document Server

    Cataldo, Mauricio

    2013-01-01

    We investigate a family of inhomogeneous and anisotropic gravitational fields exhibiting a future singularity at a finite value of the proper time. The studied spherically symmetric spacetimes are asymptotically Friedmann-Robertson-Walker at spatial infinity and describe wormhole configurations filled with two matter components: one inhomogeneous and anisotropic fluid and another isotropic and homogeneously distributed fluid, characterized by the supernegative equation of state \\omega=p/\\rho < -1. In previously constructed wormholes, the notion of the phantom energy was used in a more extended sense than in cosmology, where the phantom energy is considered a homogeneously distributed fluid. Specifically, for some static wormhole geometries the phantom matter was considered as an inhomogeneous and anisotropic fluid, with radial and lateral pressures satisfying the relations $p_{r}/\\rho<-1$ and $p_{_l} \

  11. Confronting Phantom Dark Energy with Observations

    CERN Document Server

    Wang, Pao-Yu; Chen, Pisin

    2012-01-01

    We confront two types of phantom dark energy potential with observational data. The models we consider are the power-law potential, $V\\propto {\\phi}^{\\mu}$, and the exponential potential, $V\\propto \\exp({\\lambda}{\\phi}/{M_P})$. We fit the models to the latest observations from SN-Ia, CMB and BAO, and obtain tight constraints on parameter spaces. Furthermore, we apply the goodness-of-fit and the information criteria to compare the fitting results from phantom models with that from the cosmological constant and the quintessence models presented in our previous work. The results show that the cosmological constant is statistically most preferred, while the phantom dark energy fits slightly better than the quintessence does.

  12. Cosmological perturbations in transient phantom inflation scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Richarte, Martin G. [Universidade Federal do Parana, Departamento de Fisica, Caixa Postal 19044, Curitiba (Brazil); Universidad de Buenos Aires, Ciudad Universitaria 1428, Departamento de Fisica, Facultad de Ciencias Exactas y Naturales, Buenos Aires (Argentina); Kremer, Gilberto M. [Universidade Federal do Parana, Departamento de Fisica, Caixa Postal 19044, Curitiba (Brazil)

    2017-01-15

    We present a model of inflation where the inflaton is accommodated as a phantom field which exhibits an initial transient pole behavior and then decays into a quintessence field which is responsible for a radiation era. We must stress that the present unified model only deals with a single field and that the transition between the two eras is achieved in a smooth way, so the model does not suffer from the eternal inflation issue. We explore the conditions for the crossing of the phantom divide line within the inflationary era along with the structural stability of several critical points. We study the behavior of the phantom field within the slow-climb approximation along with the necessary conditions to have sufficient inflation. We also examine the model at the level of classical perturbations within the Newtonian gauge and determine the behavior of the gravitational potential, contrast density and perturbed field near the inflation stage and the subsequent radiation era. (orig.)

  13. Photoacoustic investigation of a neonatal skull phantom

    Science.gov (United States)

    Volinski, Bridget; Hariri, Ali; Fatima, Afreen; Xu, Qiuyun; Nasiriavanaki, Mohammadreza

    2017-03-01

    There is a need for continued research into the diagnosis, prevention and cure of neonatal brain disease and disorders. These disorders lead to fatalities and developmental disorders in infants. Non-invasive imaging techniques are being researched for this purpose. However, the availability of neonatal skull samples for this work is very low. A phantom can be used to simulate the neonatal skull and brain to improve imaging techniques. This study selects a phantom of polyurethane and titanium dioxide and proves its value as a replacement for neonatal skull in research. The methods used for this proof are validation of choice against the literature, transmissivity and acoustic experimentation compared to existing literature, and finally photoacoustic evaluation of the final choice to show its usefulness as a neonatal skull phantom.

  14. Acoustic hemostasis device for automated treatment of bleeding in limbs

    Science.gov (United States)

    Sekins, K. Michael; Zeng, Xiaozheng; Barnes, Stephen; Hopple, Jerry; Kook, John; Moreau-Gobard, Romain; Hsu, Stephen; Ahiekpor-Dravi, Alexis; Lee, Chi-Yin; Ramachandran, Suresh; Maleke, Caroline; Eaton, John; Wong, Keith; Keneman, Scott

    2012-10-01

    A research prototype automated image-guided acoustic hemostasis system for treatment of deep bleeding was developed and tested in limb phantoms. The system incorporated a flexible, conformal acoustic applicator cuff. Electronically steered and focused therapeutic arrays (Tx) populated the cuff to enable dosing from multiple Tx's simultaneously. Similarly, multiple imaging arrays (Ix) were deployed on the cuff to enable 3D compounded images for targeting and treatment monitoring. To affect a lightweight cuff, highly integrated Tx electrical circuitry was implemented, fabric and lightweight structural materials were used, and components were minimized. Novel cuff and Ix and Tx mechanical registration approaches were used to insure targeting accuracy. Two-step automation was implemented: 1) targeting (3D image volume acquisition and stitching, Power and Pulsed Wave Doppler automated bleeder detection, identification of bone, followed by closed-loop iterative Tx beam targeting), and 2) automated dosing (auto-selection of arrays and Tx dosing parameters, power initiation and then monitoring by acoustic thermometry for power shut-off). In final testing the device automatically detected 65% of all bleeders (with various bleeder flow rates). Accurate targeting was achieved in HIFU phantoms with end-dose (30 sec) temperature rise reaching the desired 33-58°C. Automated closed-loop targeting and treatment was demonstrated in separate phantoms.

  15. Supernumerary breast. A case Presentation Mama supernumeraria. Presentación de un caso

    Directory of Open Access Journals (Sweden)

    Juan Miguel Guerra Cabrera

    2010-07-01

    Full Text Available Congenital malformations of the breast appear in 10 % of the population. The existence of mammary tissue at any line of the breast is classified according to Kajava’s categories into eight classes which differ one from the other in the presence or absence of the areola of the breast, nipple and glandular tissue. This report presents a case of a puerpera who had delivered her child seven days before her attendance to hospital. She presented with discharge from her both axillae. On physical examination, a supernumerary nipple with milky secretion out from it was found in her right axilla and secretion throughout the contralateral axilla through the skin pores, with absence of nipple and areola in that axillary region. The echographic study revealed the presence of bilateral ectopic mammary tissue. This case belongs to Kajava’s class IV classification in the left axilla and a variery of Type I in the right axilla. In facing a mammary malformation, a conservative attitude seems to be the most appropriate although esthetics requires surgery. To keep into account the presence of supernumerary breasts will be a need for the prevention of breast cancer. This case has been presented due to all these reasons and the unusual features of this case.Las malformaciones congénitas de la mama aparecen hasta en un 10 % de la población. La existencia de tejido mamario en algún punto de las líneas mamarias se clasifica, según Kajava, en 8 clases, que se diferencian por la presencia o no de areola mamaria, pezón y tejido glandular. Se presenta el caso de una paciente con secreción por ambas axilas en su séptimo día de puerperio. En la exploración se detectó un pezón supernumerario en axila derecha con secreción láctea a través de este y secreción a través de la axila contra lateral por los poros de la piel, con ausencia de pezón y de areola. El estudio ecográfico demostró la presencia de tejido mamario ectópico bilateral. Este caso pertenece

  16. Standard operating procedure to prepare agar phantoms

    Science.gov (United States)

    Souza, R. M.; Santos, T. Q.; Oliveira, D. P.; Souza, R. M.; Alvarenga, A. V.; Costa-Felix, R. P. B.

    2016-07-01

    Agar phantoms are widely used as soft tissue mimics and some preparation techniques are described in the literature. There are also standards that describe the recipe of a soft tissue mimicking material (TMM). However some details of manufacture process are not clearly defined. The standardization of the phantom's preparation can produce a metrological impact on the results of the acoustic properties measured. In this direction, this paper presents a standard operating procedure (SOP) to prepare the agar TMM described on the IEC 60601-237.

  17. Supernumerary registrar experience at the University of Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    S Peer

    2017-01-01

    Full Text Available Background. Despite supernumerary registrars (SNRs being hosted in South African (SA training programmes, there are no reports of their experience. Objectives. To evaluate the experience of SNRs at the University of Cape Town, SA, and the experience of SNRs from the perspective of SA registrars (SARs. Methods. SNRs and SARs completed an online survey in 2012. Results. Seventy-three registrars responded; 42 were SARs and 31 were SNRs. Of the SNRs 47.8% were self-funded, 17.4% were funded through private organisations, and 34.8% were funded by governments. Average annual income was ZAR102 349 (range ZAR680 - 460 000. Funding was considered insufficient by 61.0%. Eighty-seven percent intended to return to their home countries. Personal sacrifices were deemed worthwhile from academic (81.8% and social (54.5% perspectives, but not financially (33.3%. Only a small majority were satisfied with the orientation provided and with assimilation into their departments. Almost half experienced challenges relating to cultural and social integration. Almost all SARs supported having SNRs. SNRs reported xenophobia from patients (23.8% and colleagues (47.8%, and felt disadvantaged in terms of learning opportunities, academic support and on-call allocations. Conclusions. SNRs are fee-paying students and should enjoy academic and teaching support equal to that received by SARs. Both the university and the teaching hospitals must take steps to improve the integration of SNRs and ensure that they receive equal access to academic support and clinical teaching, and also need to take an interest in their financial wellbeing. Of particular concern are perceptions of xenophobia from SA medical colleagues.

  18. Small supernumerary marker chromosomes (sSMC in humans; are there B chromosomes hidden among them

    Directory of Open Access Journals (Sweden)

    Ogilvie Caroline

    2008-06-01

    Full Text Available Abstract Background Small supernumerary marker chromosomes (sSMC and B-chromosomes represent a heterogeneous collection of chromosomes added to the typical karyotype, and which are both small in size. They may consist of heterochromatic and/or euchromatic material. Also a predominance of maternal transmission was reported for both groups. Even though sSMC and B-chromosomes show some similarity it is still an open question if B-chromosomes are present among the heterogeneous group of sSMC. According to current theories, sSMC would need drive, drift or beneficial effects to increase in frequency in order to become B chromosome. However, up to now no B-chromosomes were described in human. Results Here we provide first evidence and discuss, that among sSMC B-chromosomes might be hidden. We present two potential candidates which may already be, or may in future evolve into B chromosomes in human: (i sSMC cases where the marker is stainable only by DNA derived from itself; and (ii acrocentric-derived inverted duplication sSMC without associated clinical phenotype. Here we report on the second sSMC stainable exclusively by its own DNA and show that for acrocentric derived sSMC 3.9× more are familial cases than reported for other sSMC. Conclusion The majority of sSMC are not to be considered as B-chromosomes. Nonetheless, a minority of sSMC show similarities to B-chromosomes. Further studies are necessary to come to final conclusions for that problem.

  19. 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

  20. Body image and self-esteem in lower-limb amputees.

    Directory of Open Access Journals (Sweden)

    Lukas A Holzer

    Full Text Available BACKGROUND: Limb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL. METHODS: 298 patients (149 uni- or bilateral lower-limb amputees and 149 controls were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ, the Rosenberg Self-esteem (RSE scale and the SF-36 Health Survey (QoL. ANOVA and student's t-test were used for statistical analysis. RESULTS: Unilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (p<0.001 and a lower score in the RSE compared to controls (21.63±4.72 vs. 21.46±5.86. However, differences were not statistically significant (p = 0.36. Patients with phantom pain sensation had a significantly reduced RSE (p = 0.01. The SF-36 health survey was significantly lower in patients with lower-limb amputation compared to controls (42.17±14.47 vs. 64.05±12.39 (p<0.001. CONCLUSION: This study showed that lower-limb amputations significantly influence patients' body image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation.

  1. Esthetic and endodontic management of fused maxillary lateral incisor and supernumerary teeth with all ceramic restoration after trauma

    Directory of Open Access Journals (Sweden)

    Kiranmeet Kaur Khurana

    2014-01-01

    Full Text Available Double or fusion of the teeth is a primary developmental anomaly union of two independently developing primary or permanent teeth. The tooth fusion may contribute to various significant problems such as crowding, caries and periodontal diseases. Fused teeth require an interdisciplinary approach combining the endodontic, esthetic and prosthetic treatments. All ceramic restoration meets the requirement of better appearance, biocompatibility and long life. By using restorative therapy esthetic and functional criteria were satisfied. Management of a case of fusion of a maxillary lateral incisor and a supernumerary tooth is presented.

  2. Supernumerary teeth and pseudarthrosis of the mandible in a young male from the mediaeval cemetery in Stenjevec

    Directory of Open Access Journals (Sweden)

    Željka Bedić

    2010-06-01

    Full Text Available Anthropological analysis of a young adult male from the mediaeval Stenjevec skeletal series revealed supernumerary teeth on both sides of the mandible, and an un-united subcondylar fracture of the mandible. The first condition is a developmental abnormality, while subcondylar fractures are one of the most frequent fractures of the mandible. Although, the osteological collection of the Department of Archaeology of the Croatian academy of Sciences and Arts consists of nearly 5,500 skeletons, this is the first documented case that exhibits these conditions in Croatian archaeological skeletal series.

  3. Multiple Impacted Permanent and Supernumerary Teeth in the Anterior Mandible of Nonsyndromic Case: A Systematic Review and Multidisciplinary Approach to Management

    Directory of Open Access Journals (Sweden)

    Pushkar Gawande

    2015-01-01

    Full Text Available Multiple impacted permanent and supernumerary teeth have been associated with the syndromes and metabolic disorders. Approximately, 75% of all the supernumerary teeth are impacted and are asymptomatic. Consequently, most such teeth constitute casual findings in the context of routine X-ray studies. Lack of eruptive force and rotation of tooth buds may cause multiple impactions, and additional examinations may be necessary to exclude systemic and metabolic conditions. We present a rare nonsyndromic case with 11 multiple impacted teeth in the anterior mandible, with systematic literature review and multidisciplinary management.

  4. Phantom breast sensations are frequent after mastectomy

    DEFF Research Database (Denmark)

    Hansen, Dorthe Marie Helbo; Kehlet, Henrik; Gärtner, Rune

    2011-01-01

    Phantom breast sensation (PBS) following mastectomy has been recognized for many years. PBS is a feeling that the removed breast is still there. The reported prevalence and risk factors have not been established in large well-defined patient series. The purpose of this study was to examine...

  5. Note on the Schwarzschild-phantom wormhole

    CERN Document Server

    Lukmanova, Regina; Izmailov, Ramil; Yanbekov, Almir; Karimov, Ramis; Potapov, Alexander A

    2016-01-01

    Recently, it has been shown by Lobo, Parsaei and Riazi (LPR) that phantom energy with $\\omega =p_{r}/\\rho <-1$ could support phantom wormholes. Several classes of such solutions have been derived by them. While the inner spacetime is represented by asymptotically flat phantom wormhole that have repulsive gravity, it is most likely to be unstable to perturbations. Hence, we consider a situation, where a phantom wormhole is somehow trapped inside a Schwarzschild sphere across a thin shell. Applying the method developed by Garcia, Lobo and Visser (GLV), we shall exemplify that the shell can possess zones of stability depending on certain constraints. It turns out that zones corresponding to "force" constraint are more restrictive than those from the "mass" constraint. We shall also enumerate the interior energy content by using the gravitational energy integral proposed by Lynden-Bell, Katz and Bi% \\v{c}\\'ak. It turns out that, even though the interior mass is positive, the integral implies repulsive energy. ...

  6. Phantom breast sensations are frequent after mastectomy

    DEFF Research Database (Denmark)

    Hansen, Dorthe Marie Helbo; Kehlet, Henrik; Gærtner, Rune

    2011-01-01

    Phantom breast sensation (PBS) following mastectomy has been recognized for many years. PBS is a feeling that the removed breast is still there. The reported prevalence and risk factors have not been established in large well-defined patient series. The purpose of this study was to examine...... the prevalence of PBS following mastectomy and associated risk factors....

  7. A precise CT phantom alignment procedure.

    Science.gov (United States)

    Schneiders, N J; Bushong, S C

    1980-01-01

    Two of the AAPM CT performance phantom inserts require precise alignment. We present a method for aligning an insert which makes use of the partial volume effect. We demonstrate that the procedure is sensitive to tilts of less than one degree and, using the slice thickness insert, allows reproducible positioning.

  8. An unusual double supernumerary maxillary mesiodens in a Middle Iron Age skeleton from South Uist, Western Isles, Scotland.

    Science.gov (United States)

    Ives, Rachel

    2014-06-01

    Bilaterally occurring and fully erupted mesiodens occur infrequently in the modern population and have been little documented from past populations. This research presents an unusual case of a double maxillary mesiodens in the permanent dentition occurring in skeletal remains dating to the Middle Iron Age (250-410 AD) from South Uist, Western Isles of Scotland. Osteological analysis of an adult male included the inventory of teeth present/absent and analysis of dental pathologies (caries, calculus, periodontal disease, ante-mortem tooth loss, periapical abscesses), developmental defects and orthodontic anomalies (enamel hypoplastic defects, malposition, rotation, crowding, agenesis and supernumerary teeth). An unusual expression of double, fully erupted, mesiodens in the anterior permanent maxillary dentition representing supernumerary central incisors exists. The complete eruption had contributed to anterior displacement of one central incisor alveolar socket similar to documented modern clinical cases. Shallow sockets also implied an associated stunted development of the original central maxillary incisor roots. Occlusal enamel wear indicated the mesiodens had been abraded during mastication. Current clinical data suggest there is a much higher tendency for single mesiodens to exist rather than double and examples often fail to fully erupt into the dentition. This relative rarity may account for the few previous reports of this dental anomaly from past human remains and especially of this date. The fully erupted double example from South Uist contributes to the known evidence for orthodontic anomalies in the past. Copyright © 2014 Elsevier Ltd. All rights reserved.

  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. [Comparable disorder of the body schema in patients with complex regional pain syndrome (CRPS) and phantom pain].

    Science.gov (United States)

    Reinersmann, A; Haarmeyer, G S; Blankenburg, M; Frettlöh, J; Krumova, E K; Ocklenburg, S; Maier, C

    2011-09-01

    In patients with complex regional pain syndrome (CRPS) a disruption of the body schema has been shown in an altered cortical representation of the hand and in delayed reaction times (RT) in the hand laterality recognition task. However, the role of attentional processes or the effect of isolated limb laterality training has not yet been clarified. The performance of healthy subjects (n = 38), CRPS patients (n = 12) and phantom limb pain (PLP) patients (n = 12) in a test battery of attentional performance (TAP) and in a limb laterality recognition task was compared and the effect of limb laterality training in CRPS patients and healthy subjects evaluated. The RTs of both CRPS and PLP patients were significantly slower than those of healthy subjects despite normal TAP values. The CRPS and PLP patients showed bilaterally delayed RTs. Through training RTs improved significantly but the RTs of CRPS patients remained slower than those of healthy subjects. In this study an equal disruption of the body schema was found in both CRPS and PLP patients which cannot be accounted for by attentional processes. For CRPS patients this disorder cannot be fully reversed by isolated limb laterality recognition training.

  12. Dosage Effects of X and Y Chromosomes on Language and Social Functioning in Children with Supernumerary Sex Chromosome Aneuploidies: Implications for Idiopathic Language Impairment and Autism Spectrum Disorders

    Science.gov (United States)

    Lee, Nancy Raitano; Wallace, Gregory L.; Adeyemi, Elizabeth I.; Lopez, Katherine C.; Blumenthal, Jonathan D.; Clasen, Liv S.; Giedd, Jay N.

    2012-01-01

    Background: Supernumerary sex chromosome aneuploidies (X/Y-aneuploidies), the presence of extra X and/or Y chromosomes, are associated with heightened rates of language impairments and social difficulties. However, no single study has examined different language domains and social functioning in the same sample of children with tri-, tetra-, and…

  13. Phantom cosmology and Boltzmann brains problem

    CERN Document Server

    Astashenok, Artyom V; Yurov, Valerian V

    2013-01-01

    We consider the well-known Boltzmann brains problem in frames of simple phantom energy models with little rip, big rip and big freeze singularity. It is showed that these models (i) satisfy to observational data and (ii) may be free from Boltzmann brains problem. The human observers in phantom models can exist only in during for a certain period $t

  14. Photoacoustic microscopy of bilirubin in tissue phantoms

    Science.gov (United States)

    Zhou, Yong; Zhang, Chi; Yao, Da-Kang; Wang, Lihong V.

    2012-12-01

    Determining both bilirubin's concentration and its spatial distribution are important in disease diagnosis. Here, for the first time, we applied quantitative multiwavelength photoacoustic microscopy (PAM) to detect bilirubin concentration and distribution simultaneously. By measuring tissue-mimicking phantoms with different bilirubin concentrations, we showed that the root-mean-square error of prediction has reached 0.52 and 0.83 mg/dL for pure bilirubin and for blood-mixed bilirubin detection (with 100% oxygen saturation), respectively. We further demonstrated the capability of the PAM system to image bilirubin distribution both with and without blood. Finally, by underlaying bilirubin phantoms with mouse skins, we showed that bilirubin can be imaged with consistent accuracy down to >400 μm in depth. Our results show that PAM has potential for noninvasive bilirubin monitoring in vivo, as well as for further clinical applications.

  15. Cosmological perturbations on the phantom brane

    Science.gov (United States)

    Bag, Satadru; Viznyuk, Alexander; Shtanov, Yuri; Sahni, Varun

    2016-07-01

    We obtain a closed system of equations for scalar perturbations in a multi-component braneworld. Our braneworld possesses a phantom-like equation of state at late times, weff Consequently, the quasi-static approximation of Koyama and Maartens provides a good fit to the exact results during the matter-dominated epoch. We find that the late-time growth of density perturbations on the brane proceeds at a faster rate than in ΛCDM. Additionally, the gravitational potentials Φ and Ψ evolve differently on the brane than in ΛCDM, for which Φ = Ψ. On the brane, by contrast, the ratio Φ/Ψ exceeds unity during the late matter-dominated epoch (z lesssim 50). These features emerge as smoking gun tests of phantom brane cosmology and allow predictions of this scenario to be tested against observations of galaxy clustering and large-scale structure.

  16. Toxicology Analysis of Tissue-Mimicking Phantom Made From Gelatin

    Science.gov (United States)

    Dolbashid, A. S.; Hamzah, N.; Zaman, W. S. W. K.; Mokhtar, M. S.

    2017-06-01

    Skin phantom mimics the biological skin tissues as it have the ability to respond to changes in its environment. The development of tissue-mimicking phantom could contributes towards the reduce usage of animal in cosmetics and pharmacokinetics. In this study, the skin phantoms made from gelatin were tested with four different commonly available cosmetic products to determine the toxicity of each substance. The four substances used were; mercury-based whitening face cream, carcinogenic liquid make-up foundation, paraben-based acne cleanser, and organic lip balm. Toxicity test were performed on all of the phantoms. For toxicity testing, topographical and electrophysiological changes of the phantoms were evaluated. The ability of each respective phantom to react with mild toxic substances and its electrical resistance were analysed in to determine the toxicity of all the phantom models. Four-electrode method along with custom made electrical impedance analyser was used to differentiate electrical resistance between intoxicated phantom and non-intoxicated phantom in this study. Electrical resistance values obtained from the phantom models were significantly higher than the control group. The result obtained suggests the phantom as a promising candidate to be used as alternative for toxicology testing in the future.

  17. Pipe Phantoms With Applications in Molecular Imaging and System Characterization.

    Science.gov (United States)

    Wang, Shiying; Herbst, Elizabeth B; Pye, Stephen D; Moran, Carmel M; Hossack, John A

    2017-01-01

    Pipe (vessel) phantoms mimicking human tissue and blood flow are widely used for cardiovascular related research in medical ultrasound. Pipe phantom studies require the development of materials and liquids that match the acoustic properties of soft tissue, blood vessel wall, and blood. Over recent years, pipe phantoms have been developed to mimic the molecular properties of the simulated blood vessels. In this paper, the design, construction, and functionalization of pipe phantoms are introduced and validated for applications in molecular imaging and ultrasound imaging system characterization. There are three major types of pipe phantoms introduced: 1) a gelatin-based pipe phantom; 2) a polydimethylsiloxane-based pipe phantom; and 3) the "Edinburgh pipe phantom." These phantoms may be used in the validation and assessment of the dynamics of microbubble-based contrast agents and, in the case of a small diameter tube phantom, for assessing imaging system spatial resolution/contrast performance. The materials and procedures required to address each of the phantoms are described.

  18. Fabrication of Two Flow Phantoms for Doppler Ultrasound Imaging.

    Science.gov (United States)

    Zhou, Xiaowei; Kenwright, David A; Wang, Shiying; Hossack, John A; Hoskins, Peter R

    2017-01-01

    Flow phantoms are widely used in studies associated with Doppler ultrasound measurements, acting as an effective experimental validation system in cardiovascular-related research and in new algorithm/instrumentation development. The development of materials that match the acoustic and mechanical properties of the vascular system is of great interest while designing flow phantoms. Although recipes that meet the flow phantom standard defined by the International Electrotechnical Commission 61685 are already available in the literature, the standard procedure for material preparations and phantom fabrications has not been well established. In this paper, two types of flow phantoms, with and without blood vessel mimic, are described in detail in terms of the material preparation and phantom fabrication. The phantom materials chosen for the two phantoms are from published phantom studies, and their physical properties have been investigated previously. Both the flow phantoms have been scanned by ultrasound scanners and images from different modes are presented. These phantoms may be used in the validation and characterization of Doppler ultrasound measurements in blood vessels with a diameter above 1 mm.

  19. Semen collection using phantom in dromedary camel.

    Science.gov (United States)

    Ziapour, S; Niasari-Naslaji, A; Mirtavousi, M; Keshavarz, M; Kalantari, A; Adel, H

    2014-12-10

    Semen collection is relatively long, unsafe, and tedious procedure in dromedary camel. The innovation of safe, hygienic, and simple approach to collect semen could make great progress in development of AI program in this species. This study investigated two methods of semen collection using phantom and artificial vagina in dromedary camel. Semen was collected using phantom (n = 4 bulls; 26 collections) and artificial vagina (n = 6 bulls; 11 collections) and diluted with INRA96 at the ratio of 1:10. The duration of semen collection, semen parameters, and morphometric features of sperm were evaluated. For specimen collected through phantom and AV, the respected duration of semen collection (411.2 ± 48.19 vs 326 ± 37.05 sec), volume (6.6 ± 0.87 vs 6 ± 1.57 ml), osmolarity (328 ± 1.6 vs 319.4 ± 3.21 mOsm/kg H2O), pH (7.7 ± 0.06 vs 7.9 ± 0.16) of semen, concentration (161.4 ± 44.05 × 10(6)/mL vs 160.2 ± 58.42 × 10(6)/mL), total motility (84.1 ± 1.89 vs 78.3 ± 3.97%), progressive forward motility (45.5 ± 3.69 vs 44.3 ± 6.41%), live percentage (72.2 ± 3.11 vs 76 ± 2.53%), and plasma membrane integrity (61.5 ± 2.49 vs 58.9 ± 4.19%) of sperm were similar (P > 0.05). The number of specimens contaminated with visible particles was greater using AV (72.7%) compared to phantom (0%; P dromedary camel.

  20. Phantoms for Radiation Measurements of Mobile Phones

    DEFF Research Database (Denmark)

    Pedersen, Gert Frølund

    2001-01-01

    Measurements of radiation efficiency for a handheld phone equipped with a patch and a helical antenna operated near the human user have been performed. Both measurements include a simple head plus hand phantom and live persons are considered. The position of the hand on the phone is found...... to be the main reason for the large variation in radiation efficiency among persons. The tilt angle of the phone and the distance between the head and phone only play a minor role...

  1. Automatic Synthesis of Anthropomorphic Pulmonary CT Phantoms.

    Directory of Open Access Journals (Sweden)

    Daniel Jimenez-Carretero

    Full Text Available The great density and structural complexity of pulmonary vessels and airways impose limitations on the generation of accurate reference standards, which are critical in training and in the validation of image processing methods for features such as pulmonary vessel segmentation or artery-vein (AV separations. The design of synthetic computed tomography (CT images of the lung could overcome these difficulties by providing a database of pseudorealistic cases in a constrained and controlled scenario where each part of the image is differentiated unequivocally. This work demonstrates a complete framework to generate computational anthropomorphic CT phantoms of the human lung automatically. Starting from biological and image-based knowledge about the topology and relationships between structures, the system is able to generate synthetic pulmonary arteries, veins, and airways using iterative growth methods that can be merged into a final simulated lung with realistic features. A dataset of 24 labeled anthropomorphic pulmonary CT phantoms were synthesized with the proposed system. Visual examination and quantitative measurements of intensity distributions, dispersion of structures and relationships between pulmonary air and blood flow systems show good correspondence between real and synthetic lungs (p > 0.05 with low Cohen's d effect size and AUC values, supporting the potentiality of the tool and the usefulness of the generated phantoms in the biomedical image processing field.

  2. Automatic Synthesis of Anthropomorphic Pulmonary CT Phantoms

    Science.gov (United States)

    Jimenez-Carretero, Daniel; San Jose Estepar, Raul; Diaz Cacio, Mario; Ledesma-Carbayo, Maria J.

    2016-01-01

    The great density and structural complexity of pulmonary vessels and airways impose limitations on the generation of accurate reference standards, which are critical in training and in the validation of image processing methods for features such as pulmonary vessel segmentation or artery–vein (AV) separations. The design of synthetic computed tomography (CT) images of the lung could overcome these difficulties by providing a database of pseudorealistic cases in a constrained and controlled scenario where each part of the image is differentiated unequivocally. This work demonstrates a complete framework to generate computational anthropomorphic CT phantoms of the human lung automatically. Starting from biological and image-based knowledge about the topology and relationships between structures, the system is able to generate synthetic pulmonary arteries, veins, and airways using iterative growth methods that can be merged into a final simulated lung with realistic features. A dataset of 24 labeled anthropomorphic pulmonary CT phantoms were synthesized with the proposed system. Visual examination and quantitative measurements of intensity distributions, dispersion of structures and relationships between pulmonary air and blood flow systems show good correspondence between real and synthetic lungs (p > 0.05 with low Cohen’s d effect size and AUC values), supporting the potentiality of the tool and the usefulness of the generated phantoms in the biomedical image processing field. PMID:26731653

  3. 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.

  4. 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

  5. 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.

  6. A study of partial volume effect on SPECT imaging using myocardial phantom. With HCM (ASH) model myocardial phantom

    Energy Technology Data Exchange (ETDEWEB)

    Onoguchi, Masahisa [Kanazawa Univ. (Japan). School of Medicine

    1997-05-01

    In order to evaluate simultaneously both myocardial perfusion and regional wall motion using ECG-gated myocardial SPECT imaging, correction for the partial volume effect (PVE) should be performed. For the quantitative analysis of myocardial SPECT imaging in patients with hypertrophic cardiomyopathy (HCM), we formed a new phantom simulating HCM with various septal wall thicknesses and estimated PVE using the recovery coefficient (RC). The value of RC in all phantoms increased with increasing thickness of the septal wall reaching a plateau at 25 mm for the cylindrical phantom and 25 mm for the Ep-phantom. Compared with the RC value, the PMMA-phantom had little influence on PVE. Therefore, our results suggested that the count in the septal wall could be underestimated if PVE was corrected by the value obtained for the cylindrical phantom. In conclusion, our new phantom simulating HCM was useful in assessing PVE in the hypertrophic septal wall. (author)

  7. Analysis of 193 Mammographic phantom images

    Energy Technology Data Exchange (ETDEWEB)

    Son, Eun Ju; Kim, Eun Kyung; Ko, Kyung Hee; Kim, Young Ah; Oh, Ki Keun [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of); Chung, Sun Yang [College of Medicine, Pochon CHA Univ., Pochon (Korea, Republic of); Kim, Hyuk Joo; Cha, Seung Hwan [Korea Food and Drug Administration, Seoul (Korea, Republic of)

    2003-11-01

    To evaluate the actual state of quality control in Korea through analysis of mammographic phantom images obtained from a multicenter, and to determine the proper exposure conditions required in order to obtain satisfactory phantom images. Between April and June, 2002, 193 phantom images were referred to the Korea Food and Drug Administration for evaluation. Two radiologists recorded the number of fibers, specks and masses they contained, and the 'pass' criteria were as follows: checked number of fibers: four or more; specks, three or more; masses, three or more (a total of ten or more features). Images in which optical density was over 1.2 were classified as satisfactory. In addition, changes in the success ratio, and difference between the two groups (i.e. 'pass' and 'fail', with regard to exposure conditions and optical density) were evaluated. Among the 193 images, 116 (60.1%) passed and 77 (39.9%) failed. Among those which passed, 73/100 (73%) involved to use of a grid, 80/117 (68.3%) were obtained within the optimal kVp range, 50/111 (45.0%) involved the use of optimal mAs, and 79/112 (70.5%) were obtained within the optimal range of optical density. Among those which failed, the corresponding figures were 17/52 (32.6%), 33/66 (50.0%), 31/69 (44.9%), and 35/65 (53.8%), There were statistically significant differences between the pass and fail rates, and with regard to kVp, optical density, and the use of a grid, but with regard to mAs, statistical differences were not significant. If only phantom images with an optical density of over 1.2 [as per the rule of the Mammographic Quality Standard Act (MQSA)] was included, the success rate would fall from 60.1% to 43.0%. The pass rate for mammographic phantom images was 60.1%. If such images are to be satisfactory, they should be obtained within the optimal range of optical density, using optimal kVp and a grid.

  8. 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 ...

  9. 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...

  10. Impacted lower third molar fused with a supernumerary tooth--diagnosis and treatment planning using cone-beam computed tomography.

    Science.gov (United States)

    Ferreira-Junior, Osny; de Avila, Luciana Dorigatti; Sampieri, Marcelo Bonifácio da Silva; Dias-Ribeiro, Eduardo; Chen, Wei-liang; Fan, Song

    2009-12-01

    This paper reported a case of fusion between an impacted third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan's radiographic technique; but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography-which provides precise three-dimensional information-was used to determinate the fusion diagnosis and also to help in the surgical planning. In this case report we observed that the periapical, occlusal and panoramic were not able to show details which could only be examined through the cone-beam computed tomography.

  11. Pure and complete trisomy 18p due to a supernumerary marker chromosome associated with moderate mental retardation.

    Science.gov (United States)

    Mabboux, P; Brisset, S; Aboura, A; Pineau, D; Koubi, V; Joannidis, S; Labrune, P; Tachdjian, G

    2007-04-01

    Trisomy for the short arm of chromosome 18 or trisomy 18p, is rarely described. We report on a 13-year-old boy with minor facial anomalies, mental retardation, bilateral cryptorchidism associated with a de novo supernumerary marker chromosome (SMC). Using fluorescence in situ hybridization and comparative genomic hybridization analyses, this SMC corresponded to the p arm of chromosome 18 associated with a centromere of either chromosome 13 or 21 and nucleolus organizing regions (NORs). We report here the first case of a pure and complete trisomy 18p due to a SMC. This report and review of literature confirm that the main phenotypic anomaly associated with trisomy 18p is moderate mental retardation.

  12. Revascularization of an impacted, immature dilacerated permanent maxillary central incisor associated with odontoma and a supernumerary tooth

    Directory of Open Access Journals (Sweden)

    Priya Subramaniam

    2013-01-01

    Full Text Available To intentionally replant an impacted immature permanent maxillary central incisor in the mixed dentition period followed by revascularization in order to achieve apical root closure. A 9-year-old boy presented with retained maxillary left primary incisors. Radiographic evaluation revealed the presence of a supernumerary tooth and an odontoma associated with an impacted permanent maxillary left central incisor, having root dilaceration. Treatment included surgical removal of mesiodens and odontoma. The impacted dilacerated permanent central incisor was removed and intentionally replanted, followed by revascularization of pulp. During the follow-up, root end closure with narrowing of canal space was observed, patient has been asymptomatic and the tooth remains vital. Revascularization of the immature reimplanted tooth showed continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue and narrowing of the canal space.

  13. Characterization of a prenatally assessed de novo supernumerary minute ring chromosome 20 in a phenotypically normal male

    Directory of Open Access Journals (Sweden)

    Garas Antonios

    2009-01-01

    Full Text Available Abstract Background The heterogeneous group of small supernumerary marker chromosomes (sSMCs presents serious counseling problems, especially if they are present de novo and diagnosed prenatally. The incidence has been estimated at 1 in 1000 prenatal samples. We present a case of mosaic sSMC diagnosed prenatally after amniocentesis. The sSMC was characterized by various molecular cytogenetic techniques and determined to be a r(20 chromosome. After genetic counseling, the parents decided to continue the pregnancy, and a boy with minor phenotypic variants was born after 39 weeks of pregnancy. The case is compared with four other cases of prenatally detected r(20 mosaicism. Results Here we describe a 3 months old male child with normal pre- and postnatal development and with a de novo ring supernumerary marker chromosome in amniocytes cultures. Using new fluorescence in situ hybridization (FISH techniques, three distinguishable sSMCs (cryptic mosaicism, all derived from chromosome 20, were observed, including ring and minute chromosomes. This heterogeneity was impossible to detect by the conventional G-banding technique or conventional FISH technique that were used before the application of new FISH techniques (subcentromere-specific multicolor-FISH [subcenM-FISH] and a probe, specific for the 20p12.2 band. The sSMC present in 25% of the cells was present as r(20(::p12.2~12.3->q11.1::5/r(20;20(::p12.1->q11.1::q11.1 >p12.1::2/min(20;20(:p12.1->q11.1::q11.1->p12.1:1. The final karyotype was 47,XY,+r(20[25%]/46,XY[75%]. Conclusion We emphasize the importance of application of molecular cytogenetics in a prenatally diagnostic laboratory and description of more cases to enable a better genetic counseling and risk evaluation.

  14. 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

  15. Characterization of a phantom setup for breast conserving cancer surgery

    Science.gov (United States)

    Chadwell, Jacob T.; Conley, Rebekah H.; Collins, Jarrod A.; Meszoely, Ingrid M.; Miga, Michael I.

    2016-03-01

    The purpose of this work is to develop an anatomically and mechanically representative breast phantom for the validation of breast conserving surgical therapies, specifically, in this case, image guided surgeries. Using three patients scheduled for lumpectomy and four healthy volunteers in mock surgical presentations, the magnitude, direction, and location of breast deformations was analyzed. A phantom setup was then designed to approximate such deformations in a mock surgical environment. Specifically, commercially available and custom-built polyvinyl alcohol (PVA) phantoms were used to mimic breast tissue during surgery. A custom designed deformation apparatus was then created to reproduce deformations seen in typical clinical setups of the pre- and intra-operative breast geometry. Quantitative analysis of the human subjects yielded a positive correlation between breast volume and amount of breast deformation. Phantom results reflected similar behavior with the custom-built PVA phantom outperforming the commercial phantom.

  16. Recipes to make organic phantoms for diffusive optical spectroscopy.

    Science.gov (United States)

    Quarto, Giovanna; Pifferi, Antonio; Bargigia, Ilaria; Farina, Andrea; Cubeddu, Rinaldo; Taroni, Paola

    2013-04-10

    Three recipes are presented to make tissue constituent-equivalent phantoms of water and lipids. Different approaches to prepare the emulsion are proposed. Nature phantoms are made using no emulsifying agent, but just a professional disperser; instead Agar and Triton phantoms are made using agar or Triton X-100, respectively, as agents to emulsify water and lipids. Different water-to-lipid ratios ranging from 30% to 70% by mass were tested. A broadband time-resolved diffuse optical spectroscopy system was used to characterize the phantoms in terms of optical properties and composition. For some water/lipid ratios the emulsion fails or the phantom has limited lifetime, but in most cases the recipes provide phantoms with a high degree of homogeneity [coefficient of variation (CV) of 4.6% and 1.5% for the absorption and reduced scattering coefficient, respectively] and good reproducibility (CV of 8.3% and 12.4% for absorption and reduced scattering coefficient, respectively).

  17. Polarized light propagation through tissue and tissue phantoms

    Energy Technology Data Exchange (ETDEWEB)

    Sankaran, V; Walsh, J T JR; Maitland, D J

    2000-02-08

    We show that standard tissue phantoms can be used to mimic the intensity and polarization properties of tissue. Polarized light propagation through biologic tissue is typically studied using tissue phantoms consisting of dilute aqueous suspensions of microspheres. The dilute phantoms can empirically match tissue polarization and intensity properties. One discrepancy between the dilute phantoms and tissue exist: common tissue phantoms, such as dilute Intralipid and dilute 1-{micro}m-diameter polystyrene microsphere suspensions, depolarize linearly polarized light more quickly than circularly polarized light. In dense tissue, however, where scatterers are often located in close proximity to one another, circularly polarized light is depolarized similar to or more quickly than linearly polarized light. We also demonstrate that polarized light propagates differently in dilute versus densely packed microsphere suspensions, which may account for the differences seen between polarized light propagation in common dilute tissue phantoms versus dense biologic tissue.

  18. Development of thyroid anthropomorphic phantoms for use in nuclear medicine

    Science.gov (United States)

    Cerqueira, R. A. D.; Maia, A. F.

    2014-02-01

    The objective of this study was to develop thyroid anthropomorphic phantoms to be used in control tests of medical images in scintillation cameras. The main difference among the phantoms was the neck shape: in the first, called OSCT, it was geometrically shaped, while in the second, called OSAP, it was anthropomorphically shaped. In both phantoms, thyroid gland prototypes, which were made of acrylic and anthropomorphically shaped, were constructed to allow the simulation of a healthy thyroid and of thyroids with hyperthyroidism and hypothyroidism. Images of these thyroid anthropomorphic phantoms were obtained using iodine 131 with an activity of 8.695 MBq. The iodine 131 was chosen because it is widely used in studies of thyroid scintigraphy. The images obtained proved the effectiveness of the phantoms to simulate normal or abnormal thyroids function. These phantoms can be used in medical imaging quality control programs and, also in the training of professionals involved in the analysis of images in nuclear medicine centers.

  19. New asymptotically flat phantom wormhole solutions

    CERN Document Server

    Lobo, Francisco S N; Riazi, Nematollah

    2012-01-01

    A possible cause of the late-time cosmic acceleration is an exotic fluid with an equation of state lying within the phantom regime, i.e., $w=p/\\rho 0. Thus, there is no need to surgically paste the interior wormhole geometry to an exterior vacuum spacetime. We also consider the "volume integral quantifier", which provides useful information regarding the total amount of energy condition violating matter, and show that, in principle, it is possible to construct asymptotically flat wormhole solutions with an arbitrary small amount of energy condition violating matter.

  20. Computerized acoustical characterization system of medical phantoms

    Science.gov (United States)

    Nazihah, M. D.; Kadri, S.; Yaacob, M. I. H.; Rosly, J.

    2013-05-01

    The development of a computerized acoustical characterization system of medical phantoms is described in this paper. The system employs the insertion technique and it was developed using LabView 2011 where the ultrasound signal was acquired through the interfacing scheme of an oscilloscope to a personal computer. The system performance was validated by comparing measured acoustical properties with values obtained from the previous studies. Other than faster measurement time, the developed system carried percentage difference at less than 1.00% for all of the acoustical properties measurements at 23.0°C to 25.0°C respectively.