Brachial plexus injuries.
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Brachial Plexus↗
Biomedical subjects
A Fast
Publications and source records attributed to A Fast.
Odontoid fracture and C1-C2 subluxation in psoriatic cervical spondyloarthropathy. A case report.
STUDY DESIGN: Case presentation and review of pertinent literature. OBJECTIVES: To present an unusual case and alert other physicians to possible missed diagnoses. SUMMARY OF BACKGROUND DATA: An unusual case is presented of a young man with server psoriatic spondyloarthropathy and fusion of C2-C7 (Type II cervical psoriatic ankylosing disease) who fell at home, sustaining an unrecognized fracture of the odontoid process leading to subluxation of C1-C2 and the transitory tetraplegia. The patient presented with torticollis, and the fracture was unrecognized for a long period of time. METHODS: Case presentation. RESULTS: This patient became independent in all activities of daily living after surgery and rehabilitation despite persistence of torticollis. CONCLUSIONS: A patient who presents clinically with traumatic torticollis after minor trauma and who also has psoriasis and ankylosis of the cervical spine should be suspected of having a fracture-subluxation until definitely proven otherwise. In the present case, the late diagnosis delayed surgical stabilization.
Adult↗
Outcome for patients with leukemia, multiple myeloma and lymphoma who relapse after high dose therapy and autologous stem cell support.
Relapses after autologous transplantation are a serious clinical problem in patients with haematological diseases. The decision making for handling of such patients is difficult and the aim of this retrospective analysis of posttransplant relapses was 1) to obtain information of practical importance for the management of future relapses and 2) to evaluate the basis for clinical phase I-II trials of salvage therapy combined with biological modifiers. Included in the study were 283 patients with acute leukemia, multiple myeloma and malignant lymphoma who relapsed after autologous transplantations during a five year period from 1989 to 1994. Chemo- and radiotherapy was given to 229 patients after relapse or due to progressive disease and the response evaluated after 90 days. Fifty four patients (24%) obtained a complete remission and 44 patients (19%) partial responses. The overall median survival from relapse was 5 months. In the group given salvage treatment the median survival was 7 months and in the 54 patients who obtained remission the median survival was 15 months. So far 6 of 14 patients in continuous complete remission have a remission time after relapse longer than the time in remission after transplantation. Survival after relapse depended upon the time from transplantation to relapse, primary disease and if salvage therapy was given. In conclusion posttransplant relapses can be treated but the strategy has to be evaluated in future clinical trials.
Adolescent↗
The instrumented walker: usage patterns and forces.
Studies documenting the forces that are transmitted through a walker's frame are still scant. The purpose of this study was to evaluate the pattern and magnitude of forces that are transmitted through the frame of a walker during ambulation. A standard aluminum walker was instrumented. Gauges, which were mounted on all four legs, recorded axial, frontal, and sagittally oriented forces. A custom made computerized system registered the forces during 30 seconds of data acquisition. Twelve patients with ambulation dysfunction were tested with this system. Two different usage patterns emerged from the study. One usage pattern was observed in patients who were using the walker as a mean to reduce the amount of weight transmitted through the lower extremity. The second pattern was observed in patients with severe balance problems. These patients used the walker to enhance their balance and stability. The system described allows walker usage pattern analysis. Better understanding of force distribution and usage patterns may lead to improved or new walker design.
Adult↗
Amputation for reflex sympathetic dystrophy.
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Amputation, Surgical↗
Total knee arthroplasty in Parkinson's disease.
Total knee arthroplasty in Parkinson's disease (PD) has been reported only twice in the literature. Parkinson's disease is considered a contra-indication for total knee replacement by some authors. We report on a 77-year-old man with PD who underwent total knee arthroplasty for severe degenerative joint disease. The patient had a somewhat prolonged but successful rehabilitation as an inpatient and continued to make gains following discharge. Currently he is an independent functional ambulator. Based on our experience with this patient, we recommend that patients with PD who maintain ambulatory function prior to surgery and are cognitively able to integrate new knowledge and follow commands should be considered candidates for total knee replacement if it is indicated. Our patient demonstrates, however, that even in patients suffering from mild PD the rehabilitation process may be significantly prolonged and more difficult than in patients without PD. Objective studies evaluating the role of pre-surgical rehabilitation are needed.
Aged↗
Clinical, serological and PCR evidence of cytomegalovirus infection in the central nervous system in infancy and childhood.
Over a 3-year-period (Dec. 1990-Nov. 1993) 12 children were found PCR-positive for CMV-DNA in CSF and brain biopsies. Three of the patients were immunologically compromised. During the same period CSF samples from 10 shunt-operated children and 143 virological routine CSF samples were PCR CMV negative. Clinical association with positive PCR-CMV reaction was considered likely in 6 patients: two boys developed prolonged fever and meningoencephalitis following neurosurgery, one infant girl had a course compatible with congenital inclusion disease, and three had prolonged fever following transplantation. Clinical association was deemed probable in 3 infant girls: one had neonatal infection, meningitis and intraventricular haemorrhage, one had neonatal encephalitis and failure to thrive, and one with neonatal seizures and encephalitis developed brain atrophy. Clinical association was judged possible in 3 patients: one infant girl with no signs of encephalitis developed brain atrophy, one had an Aicardi Type 1 syndrome and one 2 1/2-year-old boy had an acute encephalitis with insufficient serological support for CMV but was 12 months later PCR positive for CMV. We conclude that CMV may be an overlooked infectious agent of the CNS also in immunocompetent children. PCR aids in rapid diagnosis of CMV infection in the immunocompromised. CMV may occasionally be disclosed with PCR in other conditions as a probably non-relevant observation.
Brain↗
Bilateral brachial plexus palsy after immediate breast reconstruction with TRAM flaps.
Although most postoperative upper extremity neuropathies are caused by extremes of position or intraoperative manipulation of the arm, nerve injury is possible without either of these. Pedicled TRAM flap surgery, during which no axillary retraction or hyperabduction of the arm is used, is not free of risk for neural injury. More studies are needed to specifically define risk-related maneuvers for these and other anesthetized patients.
Adult↗
Diabetic lumbar radiculopathy: sciatica without disc herniation.
Three patients with diabetic radiculopathy (DR) are presented. The clinical aspects of DR, its management, and differential diagnosis are reviewed. Diabetic radiculopathy commonly presents with severe unilateral pain of sudden onset that is usually located in the lower extremity, frequently in the proximal segments. Occasionally, bilateral asymmetric pain may be observed. The pain is severe and may require narcotic medications. Sphincteric involvement is rare. Weakness of hip or thigh muscles, decreased sensation and hypo- or areflexia are commonly observed. The clinical picture can resemble that of high lumbar disc herniation. Electrodiagnostic and radiological studies may help differentiate between the two conditions.
Aged↗
Sleep in normal late pregnancy.
Twelve women in their third trimester of pregnancy and 10 age-matched nonpregnant controls underwent complete polysomnography for one night in the laboratory. Seven of the original women returned for a second study 3-5 months postpartum. During late pregnancy, women showed increased wake after sleep onset (WASO) and a lower sleep efficiency in comparison with the control group. The percentage of rapid eye movement (REM) sleep was significantly decreased and the percentage of stage 1 significantly increased compared to the nonpregnant group. At 3-5 months postpartum, a significant reduction in WASO and increased sleep efficiency were noted. However, only a slight increase was noted in REM sleep during the postpartum period compared to the prepartum period. The most frequent sleep complaints in the pregnant group were restless sleep, low back pain, leg cramps and frightening dreams. In summary, in accordance with their complaints, women in their third trimester demonstrated polysomnographic patterns of sleep maintenance insomnia.
Adult↗
The effect of ice on intra-articular temperature in the knee of the dog.
The effect of surface cooling on intra-articular temperature was examined in dogs' knees. Four treatment protocols were examined: local ice compress application for 5, 15 and 30 min and local ice bath immersion for 15 min. Intra-articular temperatures were recorded using a needle microprobe inserted into the knee and continuous temperature recordings were made before, during and after the treatment. Rectal temperatures were also simultaneously recorded. Intra-articular temperatures rapidly dropped during icing. Five minutes of ice compress application resulted in a 2.2 +/- 1.2 degrees C intra-articular temperature drop with no change in rectal temperature. After 15 min of ice compress application, the joint temperature fell 4.1 +/- 1.3 degrees C with no change in rectal temperature. Thirty minutes of local ice compress application dropped the knee temperature 6.5 +/- 4.0 degrees C with a slight 0.5 +/- 0.3 degrees C drop in rectal temperature. Fifteen minutes of ice water immersion caused a much greater drop in intra-articular temperatures (20.2 +/- 8.4 degrees C) than could be achieved with ice compress. Rectal temperatures fell slightly during immersion (1.6 +/- 0.3 degrees C). After the removal of any type of cryotherapy, intra-articular temperatures continued to drop for several minutes and then a prolonged rewarming period commenced. The mean time required to return to baseline intra-articular temperature varied from 22-60 min, depending on the type and duration of cryotherapy. We conclude that brief periods of topical cold application to a dog's knee can induce significant and long lasting depression of intra-articular temperatures and that this is a local effect not dependent on core temperature cooling.
Animals↗
Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain.
An attempt was made to determine the effect of pregnancy on the abdominal muscles and to correlate changes in abdominal muscles strength with low-back pain during pregnancy. The study included 328 women. Group A consisted of 164 pregnant women; group B consisted of 164 non-pregnant women. The race, age, height, weight, parity, profession, time devoted to physical fitness per week, abdominal length, and relation between the abdominal length to height were recorded. A detailed history relating to backache prior to and during pregnancy was obtained. Each woman was asked to perform a single sit-up. The results of the study indicate that about 10% of pregnant women develop severe low-back pain that interferes with daily life activities. About 49% of the non-pregnant women complained of LBP. The pain did not interfere with activities of daily living. During pregnancy, due to overstretching of the abdominal muscles, the ability to perform a sit-up is significantly decreased. Whereas all non-pregnant women could perform a sit-up, 16.6% of pregnant women could not perform a single sit-up. There was no statistically significant correlation between the sit-up performance and backache. It may be concluded that during pregnancy the abdominal muscles become insufficient.
Abdomen↗
Obesity. A risk factor for knee dislocation.
Complete dislocation of the knee joint is a severe injury that is commonly the result of high-velocity injuries and often associated with disruption of the popliteal artery. We report two cases in which obesity appeared to be the principal cause of knee dislocation with vascular compromise. Preventive measures in extremely obese patients are recommended.
Adult↗
Night backache in pregnancy. Hypothetical pathophysiological mechanisms.
One hundred women responded to a questionnaire dealing with night backache during pregnancy. All the women were in the second half of their pregnancy. Sixty seven per cent of the women reported discomfort and/or backache during the night. We hypothesize that hypervolemia combined with obstruction of the inferior vena cava, caused by the enlarging uterus, is the underlying pathomechanism leading to night backache. Patients with inadequate venous collateral circulation may develop excessive pressure within the venous system, the vertebral bodies and overdistension of venous channels distal to the occluded zone. These changes may lead to hypoxemia, metabolic disturbances, irritation of unmyelinated nerves and result in night backache.
Back Pain↗
Motorcycle accidents and their outcome. Commentary.
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Accidents, Traffic↗
Isthmic spondylolisthesis in pycnodysostosis.
Pycnodysostosis is an inborn skeletal syndrome manifested by short stature with a concomitant spinal deformity and by dense sclerotic fragile bones. We report a 35-year-old woman with pycnodysostosis and isthmic spondylolisthesis. Pycnodysostosis should be added to the differential diagnosis of spondylolisthesis.
Adult↗
The shoulder abduction relief sign in cervical radiculopathy.
A patient with C6 cervical radiculopathy reported that sustained shoulder abduction significantly diminished this upper extremity pain. The patient was instructed to adopt this position for prolonged periods during rest and at work. Pain relief was temporary and lasted as long as the arm was in abduction. Relief of pain, induced by arm abduction, may be observed in cervical radiculopathy in which the lower cervical roots are involved. Reduced tension at the nerve root is the probable underlying mechanism that leads to pain relief. Shoulder abduction can be used not only as a diagnostic sign but also may be incorporated in the conservative management of patients suffering from cervical radiculopathy affecting the lower cervical roots.
Humans↗
Gluteal abscess causing sciatica in a patient with systemic lupus erythematosus.
Low back pain and sciatica may be caused by pathology remote from disc and lumbosacral vertebral segments. We report on a 59-year-old patient with systemic lupus erythematosis whose history illustrates this point. The patient was evaluated and diagnosed to have a septic arthritis of the wrist and lumbar spinal stenosis, for which she was treated. The patient's failure to respond to therapy led to further evaluation. A massive gluteal abscess was identified and drained, and with appropriate antibiotic therapy, the patient recovered. Patients with lupus have increased likelihood of infection, and their evaluation should include a search to discover unusual locations in cases that are unresponsive to standard and seemingly appropriate therapy.
Abscess↗