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Biomedical subjects

J Styf

Publications and source records attributed to J Styf.

At least 37 records · Page 2Linked to original sources
PubMed1998

Secondary wound closure following fasciotomy for acute compartment syndrome increases intramuscular pressure.

OBJECTIVES: To study the effects of secondary wound closure on intramuscular pressure (IMP) in patients treated by fasciotomy for acute compartment syndrome. STUDY DESIGN: Prospective experimental study with an unbiased observer. METHODS: Twelve patients (mean age, thirty years) were treated for acute compartment syndrome by fasciotomy, early postoperative edema reduction, and secondary wound closure on the third or fourth day. The syndrome was confirmed by measurements of IMP in seven legs, three thighs, and two arms. The IMP was recorded in appropriate compartments with a noninfusion technique before, during, and after secondary wound closure by wire sutures. The IMP was not allowed to exceed thirty millimeters of mercury (four kilopascals) in the underlying compartment during wound closure. Patients were followed up at thirty-six months after surgery. RESULTS: By using an IMP limit of thirty millimeters of mercury, local perfusion pressure remained above fifty millimeters of mercury in all patients. With this protocol, the wound was closed on the third or fourth day in five patients. Seven patients needed repeated secondary wound closure. The distance between skin edges did not exceed 0.5 centimeter in any of the patients by the eleventh day. No patient needed skin transplantation. None had signs of ischemic contracture at follow-up. CONCLUSION: Secondary wound closure or wound adaptation starting on the third day after fasciotomy seems to be a safe method of treatment in normotensive patients if IMP during wound closure is not allowed to exceed thirty millimeters of mercury.

Acute Disease↗
PubMed1998

Abnormally increased intramuscular pressure in human legs: comparison of two experimental models.

BACKGROUND: Abnormally increased pressure in the anterior compartment of 20 legs in 10 subjects was induced by applying venous stasis of a casted leg and external compression by a cylindrical air splint of the contralateral leg. The effects of increased intramuscular pressure (IMP) on blood perfusion pressure and clinical symptoms in the foot were compared during 30 minutes by the two methods. RESULTS: Intramuscular pressure increased to 38.9 (SD = 2.9) mm Hg when venous stasis was applied and to 39.8 (SD = 1.6) by external compression (not significant). Blood perfusion pressure in the anterior compartment decreased significantly to 25 mm Hg in both legs when they were elevated. Subjects experienced loss of sensation and muscular weakness only in the foot of the casted obstructed leg. CONCLUSIONS: Venous stasis of a casted elevated leg is an alternative experimental model to induce abnormally increased intramuscular pressure and neuromuscular dysfunction in the human leg. The venous stasis model may be better than external compression in the study of pathogenesis and pathophysiology of simulated imminent acute compartment syndrome in man.

Adult↗
PubMed1997

The superficial peroneal tunnel syndrome. Results of treatment by decompression.

We diagnosed entrapment of the superficial peroneal nerve in 17 patients (19 legs) with a mean age of 41 years. In all cases, plain radiographs of the leg, nerve-conduction studies of the superficial peroneal nerve and measurement of the intramuscular pressure at rest after exercise were normal. Diagnostic tests for nerve compression during rest after exercise produced pain and clinical signs in all. We performed decompression of the superficial peroneal tunnel in 14 patients and local fasciectomy in three. Fourteen patients (80%) were free from symptoms or satisfied with the result.

Adolescent↗
PubMed1996

Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery.

STUDY DESIGN: Intramuscular pressure and blood flow of the back muscles were evaluated topographically during posterior lumbar spine surgery. The topographic damage of the back muscle after surgery was studied. OBJECTIVE: To investigate the relationship between intramuscular pressure or blood flow during posterior lumbar surgery and the back muscle injury after surgery. SUMMARY OF BACKGROUND DATA: Latrogenic back muscle injury in an animal and human model has been reported previously. Changes of intramuscular pressure and blood flow during surgery might be related to the muscle injury. No previous study on this issue has been published. METHODS: The contact pressure between the retractor blade and muscle tissue was monitored in 10 pigs during posterior surgery of the lumbar spine. On one side, intramuscular pressure at 5, 10, and 20 mm lateral to the retractor and on the other side blood flow of the back muscle at 5 and 20 mm during surgery were measured. Histologic changes of the back muscle at 5, 10, and 20 mm to the midline were evaluated 3 hours after surgery. RESULTS: The contact pressure decreased exponentially with time. Intramuscular pressure 5 mm lateral to the retractor was 114 +/- 31 mm Hg and was significantly higher than at 10 mm and 20 mm. Blood flow markedly decreased during surgery and recovered incompletely after releasing the retractor at 5 mm and 20 mm lateral to the retractor. Blood flow at 5 mm was significantly lower than at 20 mm throughout surgery. The muscle damage 3 hours after surgery was more severe near the retractor blade. CONCLUSIONS: The back muscles were exposed to pathophysiologic condition by a retractor during posterior lumbar spine surgery. External compression by a retractor increases intramuscular pressure to levels that impede local muscle blood flow. The muscle degeneration after surgery could be explained by direct mechanical damage and by the increased intramuscular pressure of muscle tissue by the retractor.

Animals↗
PubMed1995

Knee extension torque and intramuscular pressure of the vastus lateralis muscle during eccentric and concentric activities.

The objectives of this study were to determine whether the occurrence of delayed onset muscle soreness (DOMS) for the vastus lateralis muscle was associated with elevated intramuscular pressure (IMP); and to assess, whether high eccentric forces occurred at an increased muscle length (as determined by joint angle). Therefore, peak knee extension torque, peak IMP of the vastus lateralis muscle, and the joint angle at which peak torque (JAPT) occurred were determined in eight male subjects during repetitive eccentric and concentric activities until fatigue occurred. Peak torque was significantly higher for eccentric compared to concentric activity (P < 0.01) and declined significantly for both activities (P < 0.01) throughout the protocols. When comparing the start (prior to fatigue) to the end (fatigue state), mean torque for eccentric activity declined from 191 to 147 (N.m) and for concentric activity declined from 166 to 104 (N.m). In contrast, peak IMP was not significantly different between the types of activity and did not change significantly with time. At the start and the end, the mean IMP remained constant for eccentric activity at 54 mmHg (7.2 kPa) but for concentric activity was 78 mmHg (10.4 kPa) and 96 mmHg (12.8 kPa), respectively. All the subjects, however, experienced DOMS of the vastus lateralis muscle exclusively for the eccentric activity leg. The JAPT was not different between activity types and did not change significantly with time; however, a significant interaction between activity type and time was observed (P = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Early range of motion training after ligament reconstruction of the ankle joint.

Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program, with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5 +/- 1.6 weeks compared with 8.5 +/- 1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5 +/- 2.2 weeks, compared with 12.5 +/- 2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability.

Adolescent↗
PubMed1995

Intramuscular pressure and torque during isometric, concentric and eccentric muscular activity.

Intramuscular pressures, electromyography (EMG) and torque generation during isometric, concentric and eccentric maximal isokinetic muscle activity were recorded in 10 healthy volunteers. Pressure and EMG activity were continuously and simultaneously measured side by side in the tibialis anterior and soleus muscles. Ankle joint torque and position were monitored continuously by an isokinetic dynamometer during plantar flexion and dorsiflexion of the foot. The increased force generation during eccentric muscular activity, compared with other muscular activity, was not accompanied by higher intramuscular pressure. Thus, this study demonstrated that eccentric muscular activity generated higher torque values for each increment of intramuscular pressure. Intramuscular pressures during antagonistic co-activation were significantly higher in the tibilis anterior muscle (42-46% of maximal agonistic activity) compared with the soleus muscle (12-29% of maximal agonistic activity) and was largely due to active recruitment of muscle fibers. In summary, eccentric muscular activity creates higher torque values with no additional increase of the intramuscular pressure compared with concentric and isometric muscular activity.

Adult↗
PubMed1994

Effect of ankle position and a plaster cast on intramuscular pressure in the human leg.

Intramuscular pressure was measured with transducer-tipped catheters that had been inserted into the anterior and deep posterior compartments of the leg in seven healthy adults. Intramuscular pressure increased three to sevenfold (depending on the position of the ankle) in both compartments after the application of a plaster cast from the proximal part of the thigh to the malleoli. While the cast was in place, the baseline intramuscular pressure was elevated by the inflation of a tourniquet, which was located on the proximal part of the thigh, to a pressure of sixty millimeters of mercury (8.00 kilopascals). The intramuscular pressure in both the anterior and the deep posterior compartments was found to be lowest when the ankle joint was between the neutral and the resting positions (between 0 and 37 degrees of flexion). After the cast was bivalved and the opening on each side was spread approximately one-half centimeter, there was a significant decrease in intramuscular pressure of 47 per cent in the anterior compartment and of 33 per cent in the deep posterior compartment (p < 0.05 for both).

Adult↗
PubMed1993

Intramuscular pressure and electromyography as indexes of force during isokinetic exercise.

A direct method for measuring force production of specific muscles during dynamic exercise is presently unavailable. Previous studies indicate that both intramuscular pressure (IMP) and electromyography (EMG) correlate linearly with muscle contraction force during isometric exercise. The objective of this study was to compare IMP and EMG as linear assessors of muscle contraction force during dynamic exercise. IMP and surface EMG activity were recorded during concentric and eccentric isokinetic plantarflexion and dorsiflexion of the ankle joint from the tibialis anterior (TA) and soleus (SOL) muscles of nine male volunteers (28-54 yr). Ankle torque was measured using a dynamometer, and IMP was measured via catheterization. IMP exhibited better linear correlation than EMG with ankle joint torque during concentric contractions of the SOL (IMP R2 = 0.97, EMG R2 = 0.81) and the TA (IMP R2 = 0.97, EMG R2 = 0.90), as well as during eccentric contractions (SOL: IMP R2 = 0.91, EMG R2 = 0.51; TA: IMP R2 = 0.94, EMG R2 = 0.73). IMP provides a better index of muscle contraction force than EMG during concentric and eccentric exercise through the entire range of torque. IMP reflects intrinsic mechanical properties of individual muscles, such as length-tension relationships, which EMG is unable to assess.

Adult↗
PubMed1991

Deep venous valvular function assessed with intramuscular pressure recording.

Intramuscular pressures were measured in the anterior tibial muscle with the microcapillary infusion method in 10 patients (11 limbs) with deep venous valvular insufficiency. The results were compared with pressure measurements in healthy controls (n = 8) and in patients with only superficial venous insufficiency (n = 7). The technique could differentiate patients with deep venous reflux from patients with superficial venous reflux and healthy controls. In contrast to the other two groups studied, patients with deep venous reflux were characterized by a small decrease of muscle relaxation pressure during exercise followed by a short recovery time. The method described provides a potential for evaluating regional deep venous valvular function. However, besides deep venous reflux other factors such as rate of arterial inflow, venous capacity and muscle pump function also might influence the results obtained with intramuscular pressure recordings.

Adult↗
PubMed1991

Transcapillary fluid shifts in tissues of the head and neck during and after simulated microgravity.

To understand the mechanism, magnitude, and time course of facial puffiness that occurs in microgravity, seven male subjects were tilted 6 degrees head-down for 8 h, and all four Starling transcapillary pressures were directly measured before, during, and after tilt. Head-down tilt (HDT) caused facial edema and a significant elevation of microvascular pressures measured in the lower lip: capillary pressures increased from 27.7 +/- 1.5 mmHg (mean +/- SE) pre-HDT to 33.9 +/- 1.7 mmHg by the end of tilt. Subcutaneous and intramuscular interstitial fluid pressures in the neck also increased as a result of HDT, whereas interstitial fluid colloid osmotic pressures remained unchanged. Plasma colloid osmotic pressure dropped significantly by 4 h of HDT (21.5 +/- 1.5 mmHg pre-HDT to 18.2 +/- 1.9 mmHg), suggesting a transition from fluid filtration to absorption in capillary beds between the heart and feet during HDT. After 4 h of seated recovery from HDT, microvascular pressures in the lip (capillary and venule pressures) remained significantly elevated by 5-8 mmHg above baseline values. During HDT, urine output was 126.5 ml/h compared with 46.7 ml/h during the control baseline period. These results suggest that facial edema resulting from HDT is caused primarily by elevated capillary pressures and decreased plasma colloid osmotic pressures. The negativity of interstitial fluid pressures above heart level also has implications for maintenance of tissue fluid balance in upright posture.

Adult↗
PubMed1990

The venous pump of the human foot.

Pressures in the flexor digitorum muscle, posterior tibial and anterior tibial muscles and subcutaneous pressure in the lower leg were recorded in 18 volunteers with a non-infusion technique. The venous plexus of the sole of the foot was compressed by a pneumatic foot pump. Activation of this device creates oscillations of intramuscular and subcutaneous interstitial fluid hydrostatic pressure in the lower leg. The mechanism for this is explained by intermittent passive muscle stretch. The interstitial fluid pressure decreased following active muscle contractions during venous stasis of the limb, but not following activation of the pneumatic pump. Although the pneumatic foot pump may on theoretical grounds be useful in early treatment of postoperative and post-traumatic oedema of the leg, complementary studies are necessary to establish its effectiveness.

Adolescent↗
PubMed1989

Evaluation of injection techniques in recording of intramuscular pressure.

Recording of intramuscular pressure by using the injection technique in different ways has been evaluated in 12 healthy subjects and 12 patients with medial tibial syndrome. Pressure recording with an injection needle was compared to the recording by a Teflon catheter with multiple side holes at its tip. Following an injection of 0.07 ml, the intramuscular pressure was significantly higher when it was recorded with the injection needle. Pressure recorded with an injection needle by the "meniscus method" was found to be significantly closer to the preinjection pressure compared to the injection technique described by Whitesides et al. Pressure readings by the "meniscus method" after injection, and by a catheter or needle with multiple side holes, decrease the drawbacks of the injection technique.

Adult↗
PubMed1989

Entrapment of the superficial peroneal nerve. Diagnosis and results of decompression.

Entrapment of the superficial peroneal nerve was treated in 24 legs of 21 patients by fasciotomy and neurolysis; 19 of the patients were reviewed after a mean period of 37 months. Nine were satisfied with the result, another six were improved but not satisfied because of residual limitation of athletic activity, three were unchanged and one was worse. Conduction velocity in the superficial peroneal nerve had increased after operation, but the change was not significant. In five patients the nerve had an anomalous course and in 11 there were fascial defects over the lateral compartment. Chronic lateral compartment syndrome is an unusual cause of nerve entrapment. Operative decompression produces cure or improvement in three-quarters of the cases, but is less effective in athletes.

Adolescent↗
PubMed1989

Chronic exercise-induced pain in the anterior aspect of the lower leg. An overview of diagnosis.

Clinical examination following an exercise test that elicits the symptoms of lower leg pain is most helpful in diagnosing the causes. Location of swelling, pain, impaired muscle function and impaired nerve function should all be analysed. History and clinical signs alone are insufficient to establish the diagnosis of chronic anterior compartment syndrome, and for this reason intramuscular pressure recordings have an important role in diagnosis. Different techniques for pressure recording and different pressure parameters are reviewed. Muscle relaxation pressure during exercise and intramuscular pressure at rest after exercise are the best parameters to study. Fasciotomy relieves pain in between 60% and 100% of patients. Closure of a fascial defect is never indicated, because it decreases the compartment size and may precipitate an acute compartment syndrome. Recording of nerve conduction velocity is a helpful complement in the diagnosis and evaluation of superficial peroneal nerve compression. Decompression by local fasciectomy and fasciotomy of the lateral compartment gives good results in more than 50% of patients. The value of periostitis as a clinical sign and the possibility of chronic pain following eccentric exercise are discussed.

Anterior Compartment Syndrome↗
PubMed1988

Pressure recording in the subacromial bursa.

The microcapillary infusion (MCI) technique was evaluated in monitoring pressure in the subacromial bursa in 30 shoulders in healthy volunteers. The total pressure in the bursa was studied as the volunteers held their arms at rest and as they lifted their arms and held them lifted with or without a weight of 1 kg in the hands. The pressure in the bursae at rest averaged 8 mm Hg and was found stable during a 40-min period. When the arms were lifted, the average bursa pressure increased from 8 to 39 mm Hg. As the arms were held up, the weights were put in the hands, and the average bursa pressure then further increased to 56 mm Hg. When the infusion catheters were repeatedly flushed, during a period of 5 min and with a total of 1.2 ml of saline, the average bursa pressure doubled regardless of arm position and load in the hands. The compliance of the bursae decreased from 0.09 to 0.04 ml/mm Hg when the arms were lifted and from 0.04 to 0.02 ml/mm Hg when the arms were lifted and the hands were loaded. The MCI method was found suitable for recording pressure in the subacromial bursa during exercise.

Adult↗