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At least 37 records · Page 2Linked to original sources

PubMed1996

Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: results of a prospective randomized trial. The STILE Investigators. Surgery versus Thrombolysis for Ischemia of the Lower Extremity.

PURPOSE: Early results of a prospective study that compared surgical revascularization and thrombolysis for lower extremity arterial and graft occlusions have been published. This report details the final results in patients who have native artery occlusions. METHODS: Two hundred thirty-seven patients who had lower extremity ischemia as a result of iliac-common femoral (IF; 69 patients) or superficial femoral-popliteal (FP; 168 patients) occlusion, and had symptomatically deteriorated within the past 6 months were randomized to catheter-directed thrombolysis (150 patients) or surgical revascularization (87 patients). After diagnostic arteriographic examination but before randomization, the optimal surgical procedure was determined. Lytic patients were randomized to recombinant tissue plasminogen activator (rt-PA; 84 patients) or urokinase (UK; 66 patients). Recurrent ischemia, morbidity, amputation, and death rates were determined at 30 days, 6 months, and 1 year, and were analyzed on an intent-to-treat basis. RESULTS: For patients randomized to lysis, a catheter was properly positioned and the lytic agent delivered in 78%. This provided a reduction in the predetermined surgical procedure in 58% of patients who had an FP occlusion and 51% of those who had an IF occlusion. rt-PA and UK were equally effective and safe, but lysis time was shorter with rt-PA (8 vs 24 hr; p < 0.05). At 1 year, the incidence of recurrent ischemia (64% vs 35%; p < 0.0001) and major amputation (10% vs 0%; p = 0.0024) was increased in patients who were randomized to lysis. Factors associated with a poor lytic outcome included FP occlusion, diabetes, and critical ischemia. No differences in mortality rates were observed at 1 year between the lysis and surgical groups. CONCLUSION: Surgical revascularization for lower extremity native artery occlusions is more effective and durable than thrombolysis. Thrombolysis used initially provides a reduction in the surgical procedure for a majority of patients; however, long-term outcome is inferior, particularly for patients who have an FP occlusion, diabetes, or critical ischemia.

Arterial Occlusive Diseases↗

PubMedDate not supplied

[Ablative and extremity salvage tumor surgery of the lower extremity--a 10 year comparison].

AIM: The treatment of choice for local tumor control was amputation in the 1970's. Nowadays, limb salvage procedures have become the new standard, implicating that limb salvage surgery results in a better quality of life. This study attempts to prove this hypothesis. METHOD: In total, 102 patients who survived longer than ten years after tumor treatment of the lower extremities were investigated, of these, 71 patients underwent ablative procedures compared to 31 patients with limb salvage surgery. Operative revisions, education level, and occupational situation were evaluated in both groups. To analyze the outcome of every patient regarding functional results, quality of life, life contentment, and social parameters, the functional evaluation system of the Muskulo-Skeletal-Tumor Society (MSTS), the Freiburger Life-Contentment-Questionnaire (FLZ) and the Quality of Life Questionnaire (QLQ-C-30) of the European Organization of Research and treatment of Cancer (EORTC) were used. RESULTS: Patients treated with a limb salvage procedure underwent more surgical revisions (p < 0.000). Educational level and occupational situation showed no difference in both groups. Functional results reached similar levels in both groups (74.6% vs. 73.8%). Life contentment and Quality of Life measurements showed good results in both groups. The FLZ-questionnaire showed significantly better results for the ablative group in some items. CONCLUSION: The type of surgical local therapy of lower extremity tumors has no measurable effect on quality of life according to long-term follow-up in lower extremity tumors. In cases with a risk of inadequate margins when performing limb salvage surgery, an ablative procedure should be preferred.

Activities of Daily Living↗

PubMed2001

Relationship between antiphospholipid antibodies and progression of lower extremity arterial occlusive disease after lower extremity bypass operations.

PURPOSE: Antiphospholipid antibodies (APLs), which consist of anticardiolipin antibodies (ACLs) or lupus anticoagulant (LA), are associated with venous thrombosis, stroke, and cardiac events. Although they are present in many patients with lower extremity atherosclerotic occlusive disease (LEAOD), the relationship between APL and the progression of LEAOD has not been reported. A comparison of progression of LEAOD as determined with direct imaging studies in patients with and without APL forms the basis for this report. METHODS: APL+ patients (immunoglobulin M [IgM] or IgA or IgG ACL > 3 SD units above control mean or positive LA) who underwent lower extremity bypass grafting between January 1990 and June 1999 (n = 79) were compared with an APL control group (n = 68). Members of the study and control groups were similar with respect to age, procedure, sex, length of follow-up, and multiple atherosclerosis risk factors. Progression of LEAOD was determined by comparing preoperative arteriograms with postoperative imaging studies (arteriograms or duplex scanning). External iliac, common femoral, superficial femoral and popliteal arteries were graded as < 50% stenosis, > or = 50% stenosis, or occluded. Posterior tibial and anterior tibial arteries were graded as patent or occluded. Progression was defined as any increase in stenosis category. RESULTS: The mean follow-up period was 31 months for APL+ and 35 months for APL- patients (P = not significant). Progression of LEAOD occurred in 58 (73%) of 79 APL+ patients and in 25 (37%) of 68 APL- patients (P <.001). There was no difference in progression in external iliac or common femoral arteries. Differences in progression were noted in more distal arteries; APL+ patients had significantly more progression in superficial femoral (45% vs 16%, P <.01), popliteal (31% vs 12%, P <.01), posterior tibial (29% vs 13%, P <.05), and anterior tibial arteries (29% vs 14%, P <.05). Multivariate logistic regression analysis showed a significant independent association between the presence of APL and progression of LEAOD (P <.0001). CONCLUSION: In this study, the presence of APL in patients undergoing lower extremity bypass operations was a significant independent risk factor for progression of LEAOD. We conclude that this patient group should be closely monitored in the postoperative period and appears ideally suited for prospective studies of therapies to modify LEAOD progression.

Aged↗

PubMed1989

Significance of extreme temperament in infancy for clinical status in pre-school years. I: Value of extreme temperament at 4-8 months for predicting diagnosis at 4.7 years.

The relationship between extreme temperament in infancy and clinical status at 4.7 years of age was studied in temperamentally different groups of infants matched for sex and SES, and subselected from a large birth cohort representative of the general population. The effects of certain dimensions of family functioning and of other risk factors were examined. By itself, extremely difficult temperament in infancy had no strong direct association with clinical outcome at four years of age, whereas temperament assessed at four, family attitudes to discipline, and stressful events did. However, extreme temperament in infancy might indirectly affect outcome through its association with temperament at four. The interplay between adverse temperament and parental attitudes of discipline previously observed in middle childhood might have antecedents in pre-school years.

Age Factors↗

PubMed1995

The lower extremity activity profile: a health status instrument for measuring lower extremity disability.

The Lower Extremity Activity Profile (LEAP) is a comprehensive measure of lower extremity function. It measures the client's perception of difficulty and satisfaction with performance in the following areas: self care, mobility, household activities, work, leisure activities, and social activities. The development and initial reliability and validity testing of LEAP was conducted with 32 osteoarthritis clients undergoing total knee replacement. Using a one-group repeated measures design, the LEAP, knee range of motion and self-paced walk measures were administered pre-operatively and 3 months post-operatively. The internal consistency of the LEAP using Cronbach's Alpha was 0.73. All LEAP scores showed significant improvement (p<0.01) between the two administration times demonstrating responsiveness of the measure. Correlations of LEAP with the clinical measures were moderate. LEAP is recommended for use as an outcome measure in similar populations, if used in conjunction with clinical and physical performance measures. Further testing of the LEAP is warranted for use in evaluating outcomes of rehabilitation programs addressing lower extremity musculoskeletal impairment and disability.

Activities of Daily Living↗

PubMed1985

[Purification of dopamine-beta-monooxygenase and extremely acidic, copper-containing proteins from the adrenal medulla. Extremely acidic, copper-containing proteins as electron donors for dopamine-beta-monooxygenase].

A procedure for purification of two copper-containing proteins from bovine adrenal medulla has been developed. The method is based on the extraction of proteins with Triton X-100, DEAE-cellulose chromatography and fractionation with polyethylene glycol. The yield of dopamine-beta-monooxygenase and extremely acidic copper-containing protein per 1 kg of brain medullar tissue is 100 and 150 mg, correspondingly. The ability of the reduced extremely acidic copper-containing protein to act as an electron donor in the reactions of side chain hydroxylation of tyramine and dopamine catalyzed by dopamine-beta-monooxygenase was demonstrated. The kinetics of the products formation and oxygen consumption in the course of these reactions and the specific activities of dopamine-beta-monooxygenase were compared, using the reduced extremely acidic copper-containing protein, ascorbate and ferrocyanide as cosubstrates.

Adrenal Medulla↗

PubMed1984

Second leg ischemia. Lower extremity bypass versus amputation in patients with contralateral lower extremity amputation.

Unilateral amputees with second leg ischemia may miss consideration for anything but amputation. Justification for a reconstructive approach for these ischemic second limbs was sought from a retrospective study of 108 patients who underwent lower extremity distal bypass. Risk factors and results were compared for the 12 unilateral amputees and the 96 nonamputees. Age and relative incidence of rest pain, claudication, and tissue loss were not significantly different for the two groups. Diabetes mellitus was present in 41.6 per cent of amputees and 31.3 per cent of nonamputees. Preoperative, average ankle-brachial blood pressure ratios were equal for both groups (0.3). Angiography showed comparable distribution of patients between the two groups with regard to distal run-off vessels. Operative mortality was 8 per cent for amputees and 3 per cent for nonamputees. Cumulative survival at 25 months was 67.5 per cent for amputees and 82.4 per cent for nonamputees. Cumulative patency at 6 months was 71.5 per cent for amputees compared with 63 per cent for nonamputees and at 25 months was 58.5 per cent for amputees and 37.6 per cent for nonamputees (no significant difference). Unilateral amputees appear to have similar risks and results for lower extremity distal bypass as do nonamputees. An independent, aggressive approach for evaluation and surgical revascularization should not be overlooked for the ischemic, remaining lower extremity in the dysvascular unilateral amputee.

Amputation, Surgical↗

PubMed1998

Pitfalls in the radiologic evaluation of extremity trauma: Part II. The lower extremity.

Fractures of the lower extremity are common reasons for visits to family physicians. Some lower extremity fractures are especially likely to be missed. Examples of lesions that commonly go unrecognized include sacral insufficiency or fatigue fracture, fracture of the femoral neck (especially if the fracture is nondisplaced and/or impacted), tibial plateau fracture, Segond fracture (vertical fracture of the lateral tibia), patellar fracture, calcaneal fracture of the foot, Lisfranc fracture/dislocation of the tarsometatarsal apparatus, and Jones fracture of the fifth metatarsal. Lower extremity fracture in children may suggest the possibility of child abuse, especially in the case of multiple or bilateral fractures.

Child↗

PubMed2004

The effect of upper extremity support on upper extremity posture and muscle activity during keyboard use.

Forearm support during keyboard use has been reported to reduce neck and shoulder muscle activity and discomfort. However, the effect of forearm support on wrist posture has not been examined. The aim of this study was to examine the effect of 3 different postures during keyboard use: forearm support, wrist support and "floating". The floating posture (no support) was used as the reference condition. A wrist rest was present in all test conditions. Thirteen participants completed 20 min wordprocessing tasks in each of the test conditions. Electromyography was used to monitor neck, shoulder and forearm muscle activity. Bilateral and overhead video cameras recorded left and right wrist extension, shoulder and elbow flexion and radial and ulnar deviation. The forearm support condition resulted in significantly less ulnar deviation (p < or = 0.007), less time spent in extreme ulnar deviation (p = 0.002) and less reports of discomfort than the "floating" condition (p = 0.002). The wrist support but not the forearm support condition resulted in less trapezius and anterior deltoid muscular activity (p < 0.007). These findings indicate that typing with upper extremity support in conjunction with a wrist rest may be preferable to the "floating" posture implicit in current guidelines.

Adolescent↗

PubMed1996

Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG)

This paper describes the development of an evaluative outcome measure for patients with upper extremity musculoskeletal conditions. The goal is to produce a brief, self-administered measure of symptoms and functional status, with a focus on physical function, to be used by clinicians in daily practice and as a research tool. This is a joint initiative of the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies (COMSS), and the Institute for Work and Health (Toronto, Ontario). Our approach is consistent with previously described strategies for scale development. In Stage 1, Item Generation, a group of methodologists and clinical experts reviewed 13 outcome measurement scales currently in use and generated a list of 821 items. In Stage 2a, Initial Item Reduction, these 821 items were reduced to 78 items using various strategies including removal of items which were generic, repetitive, not reflective of disability, or not relevant to the upper extremity or to one of the targeted concepts of symptoms and functional status. Items not highly endorsed in a survey of content experts were also eliminated. Stage 2b, Further Item Reduction, will be based on results of field testing in which patients complete the 78-item questionnaire. This field testing, which is currently underway in 20 centers in the United States, Canada, and Australia, will generate the final format and content of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Future work includes plans for validity and reliability testing.

Activities of Daily Living↗

PubMed1996

Combining extremely concordant sibpairs with extremely discordant sibpairs provides a cost effective way to linkage analysis of quantitative trait loci.

Extremely discordant (ED) sibpairs have been shown to be very powerful for linkage analysis of human quantitative traits [Risch and Zhang (1995) Science 268: 1584-1589]. In many cases, the extremely concordant (EC) sibpairs collected in the process of screening for ED sibpairs carry valuable information for linkage. Therefore, it seems justifiable to investigate the advantages of genotyping and to include them with the ED sibpairs for linkage analysis. Herein we explore the distributions of EC as well as ED sibpairs under various genetic models and provide a basis for combining both types of sibpairs. A simple statistic testing means of genes shared identical by descent (IBD) in applied to combine both types of EC sibpairs (high-high and low-low) with the ED pairs. We show that when a decent number of EC pairs is added to the ED sample for analysis, the power is much enhanced, making it especially desirable when the number of available ED pairs is small. We show at the same time that combining EC pairs with ED pairs is more cost effective than pursuing ED sibpairs alone.

Costs and Cost Analysis↗

PubMed2002

Biobehavioral mechanisms of work-related upper extremity disorders: a new agenda for research and practice.

BACKGROUND: Epidemiological studies provide support for the role of organizational and individual psychosocial stressors in work-related upper extremity disorders (WRUEDs). Despite this evidence, the biological plausibility of a relationship between exposure to various psychosocial and work organizational stressors and WRUEDs remains unclear METHODS: The Georgetown Symposium on Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders was held in Washington D.C. on November 6-7, 2000 to improve the understanding of potential biobehavioral mechanisms, identify future areas for research and discuss the implications of this body of knowledge for intervention. This meeting involved presentations and discussions by researchers and clinicians from a number of disciplines (epidemiology, occupational medicine, rheumatology, orthopedics, surgery, internal medicine, psychoneuroimmunology, occupational health psychology, behavioral medicine, psychophysiology and experimental and organizational psychology). RESULTS: The symposium generated several papers addressing the following topics: definitions and job stress models; epidemiological foundations; musculoskeletal and biomechanical models; central nervous system models of recurrent and persistent clinical pain; psychophysiology of work; and implications for intervention. These papers comprise this special issue. DISCUSSION: The present paper summarizes the various contributions to this special issue and provides direction for future research on potential biobehavioral pathways.

Arm↗

PubMedDate not supplied

Lower-extremity deep venous thrombosis after upper-extremity port catheter placement: an unusual complication.

We describe the case of a woman with breast carcinoma who experienced deep venous thrombosis of the right lower extremity after placement of a double-lumen central venous chemotherapy port catheter in the left upper extremity. Color Doppler sonography revealed a linear tubular structure within the right common femoral vein and sonographic features of thrombosis, suggesting deep venous thrombosis secondary to displacement of the port catheter.

Arm↗

PubMed2005

Vascular function in patients with lower extremity peripheral arterial disease: a comparison of functions in upper and lower extremities.

Peripheral arterial disease (PAD) is caused by atherosclerosis. Assessment of endothelial function in patients with PAD has been limited to that in forearm circulation in previous studies. The purpose of this study was to evaluate vascular function in upper and lower extremities in patients with PAD and to determine the relationship between the ankle-brachial pressure index (ABPI) and endothelial function in forearm and leg circulation. Forearm blood flow (FBF) and leg blood flow (LBF) responses to reactive hyperemia and sublingual administration of nitroglycerin (NTG) were measured using strain-gauge plethysmography in 57 PAD patients and 24 control patients. LBF during reactive hyperemia was significantly less in PAD patients than in control patients (p<0.001). FBF during reactive hyperemia in PAD patients was similar to that in control patients. NTG-induced vasodilation in upper and lower extremities was similar in the two groups. There was a significant relationship between the maximal LBF response to reactive hyperemia and the ABPI in both the patients with PAD and control patients (r=0.384, p<0.001), whereas maximal FBF response to reactive hyperemia was not correlated with ABPI (r=0.182, p=0.12). These findings suggest that LBF response to reactive hyperemia is impaired in PAD patients compared with that in control patients. Impairment of vascular reactivity of leg circulation may occur before impairment of vascular reactivity of forearm circulation in PAD patients and may be a better indicator of the degree of PAD than impairment of vascular reactivity of forearm circulation.

Administration, Sublingual↗

PubMed1997

Upper extremity versus lower extremity deep venous thrombosis.

BACKGROUND: In contrast to lower extremity deep venous thrombosis (LEDVT), it is widely believed that upper extremity deep venous thrombosis (UEDVT) is associated with minimal morbidity or mortality. METHODS: In an attempt to compare the two disease processes with respect to pulmonary embolism and mortality, we have reviewed records and performed interviews of 430 patients with LEDVT and 52 patients with UEDVT presenting to our institution between January 1994 and June 1995. RESULTS: Pulmonary embolism was documented by ventilation/perfusion lung scan in 9 of 52 patients (17%) with UEDVT and 33 of 430 patients (8%) with LEDVT (P <0.05). Twenty-five of the UEDVT patients (48%) died within 6 months of the diagnosis of UEDVT. Conversely, 14 patients (13%) in the LEDVT group died within 6 months of the diagnosis of LEDVT (P <0.0002). CONCLUSION: Contrary to previous reports, this study suggests that UEDVT is associated with a higher morbidity and mortality as compared with LEDVT. These data show that UEDVT has been an underrecognized predictor of morbidity and mortality.

APACHE↗

PubMedDate not supplied

The Prosthetic Upper Extremity Functional Index: development and reliability testing of a new functional status questionnaire for children who use upper extremity prostheses.

The Prosthetic Upper Extremity Functional Index (PUFI) was developed by the authors' clinical research group to evaluate the extent to which a child actually uses a prosthetic limb for daily activities, the comparative ease of task performance with and without the prosthesis, and its perceived usefulness. The PUFI's test-retest and interrater reliability were evaluated with 24 children. Intraclass coefficients (ICCs) were calculated for each of four subscales of the PUFI--specifically, method of performance, ease of prosthetic use, usefulness of the prosthesis, and ease of performance without the prosthesis. The ICCs were greater than 0.65, indicating good test-retest reliability for the older-child respondents (n = 10) and fair to good reliability (ICCs, 0.40 to 0.84) for the parent respondents overall (n= 21). Interrater (child-parent) reliability was lower, with ICCs from 0.30 to 0.77. This finding was not unexpected, since a child and parent may rate in the context of different functional environments. The prosthesis was used 53% of the time by older children and more than 75% of the time by younger children. The results provide evidence that the PUFI has good test-retest reliability overall as a measure of a child's ability to perform upper extremity activities with a prosthesis.

Activities of Daily Living↗

PubMed1997

Extremely thermostable phosphoenolpyruvate carboxylase from an extreme thermophile, Rhodothermus obamensis.

Phosphoenolpyruvate carboxylase (PEPC) was purified from an extremely thermophilic bacterium, Rhodothermus obamensis, growing optimally at 80 degrees C, which had recently been isolated from a shallow marine hydrothermal vent in Japan. The native enzyme was a homotetramer of 400 kDa in molecular mass, as estimated by gel filtration chromatography, and the subunit exhibited an apparent molecular mass of 100 kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The optimum temperature for enzyme activity was 75 degrees C. The enzyme exhibited an absolute requirement for divalent cations and a pH optimum of 8.0. The enzyme was extremely thermostable and there was no loss of enzyme activity on incubation for 2 h at 85 degrees C. The enzyme exhibited a positive allosteric property with acetyl-CoA and fructose 1,6-bisphosphate, and a negative one with L-aspartate and L-malate. These effectors affected not only the thermophilicity but also the thermostability of the enzyme, and the substrate, co-factors, and salts increased the thermostability as well. The extrinsic thermostabilization might be a possible mechanism for adaptation of the enzyme to high temperature.

Acetyl Coenzyme A↗

PubMed1994

Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS)

Recent reports using the Mangled Extremity Severity Score (MESS) suggest that a score of > or = 7 is 100% accurate in predicting the need for amputation of severely injured lower extremities. To further evaluate the value of the MESS in predicting amputation, specifically with respect to type IIIB and type IIIC (Gustilo and Anderson) open fractures of the tibia, we retrospectively evaluated 24 patients with these injuries. A significant difference (p = 0.001) between MESS values of 13 salvaged (6.36 +/- 0.35 SEM) and 11 amputated limbs (6.36 +/- 0.54 SEM) was found. A MESS value of > or = 4 was most sensitive (100%); a MESS value of > or = 7 was most specific, and a MESS value of > or = 7 was found to have a positive predictive value of 100%. Subsequently, we addressed recent criticisms of the MESS by including nerve injury in the scoring system and by separating soft-tissue and skeletal injury components of the MESS. We modified the MESS with a score called the NISSSA and applied it retrospectively to our cases. After careful statistical comparison we found both the MESS and NISSSA to be highly accurate (p < 0.005) in predicting amputation. The NISSSA was found to be more sensitive (81.8% versus 63.6%) and more specific (92.3 versus 69.2%).

Adolescent↗