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PubMed1992

Physical therapy for the patient with acquired immunodeficiency syndrome.

Treatment of HIV-infected patients has come a long way since the not-so-long-ago beginning of the AIDS epidemic. Implementation of new drug therapies has increased longevity of a patient's life after being diagnosed with the virus. Because HIV-related illnesses are consequently becoming more chronic in nature, patients commonly experience potentially debilitating CNS, PNS, or musculoskeletal problems during the course of the disease. As a result, these patients require delicate care from a number of different health care providers. A multidisciplinary team approach must be used within the podiatrist's treatment regimen. This team must include the physiatrist overseeing the physical therapist, to provide complete and optimal care to improve the patient's functional independence and quality of life. The conditions associated with HIV infection are insidious, slow, and crushing in nature. The medical community can help the patient with HIV infection and AIDS remain on his or her feet. By doing this, costs, both social and economic, can be lowered. The podiatrist must have a strong knowledge of the pathology of AIDS. He or she must use PT along with other disciplines: podiatric medicine, orthotic therapy, and general podiatric care. PT is effective in treating conditions of the lower extremities that affect the CNS, PNS, musculoskeletal system, and, lastly, rheumatologic effects of HIV infection.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Chronic coccidioidomycosis infection of the knee: a case report.

Coccidioidomycosis is a rare fungal infection caused by C immitis in endemic areas of the southwestern United States. Extrapulmonary hematogenous dissemination is a feared complication of the primary pulmonary disease. The musculoskeletal system can be involved, and disseminated musculoskeletal infections can be extremely difficult to eradicate. Surgical treatment of chronic bone and joint infections includes débridement and eventual arthrodesis for end-stage secondary osteoarthritis.

Antifungal Agents↗

PubMedDate not supplied

Measuring loss of life, health, and income due to disease and injury: a method for combining morbidity, mortality, and direct medical cost into a single measure of disease impact.

The impact of disease on a population includes illness, death, and medical care cost. Information on all three may be combined in a disease impact scale. The disease impact for a given condition can be defined as the sum of (a) the years of life lost before age 75 per 100,000 population (adjusted to reflect causes of death up to age 100); (b) the person-years of complete disability per 100,000 population, and (c) the direct medical costs in years of average annual personal income per 100,000 population.The sum of (a), (b), and (c)-disease impact in person years per 100,000 population-can be used to compare one disease with another, to estimate the potential effect of programs for risk alteration, and to measure the outcome of planned or accidental changes in society. The data necessary to calculate disease impact are becoming available in many States.In Minnesota, the total disease impact in 1978 was approximately 26,000 person-years per 100,000 population per year. The disease catgories in the International Classification of Diseases, Adapted, Eighth Revision, with the highest disease impact in the State were circulatory diseases (23.7 percent), injury and poisoning (10.9 percent), respiratory system (9.3 percent), neoplasms (9.0 percent); musculoskeletal system and connective tissue (8.8 percent), digestive system diseases (7.5 percent), and nervous system and sense organ diseases (5.8 percent). Circulatory diseases ranked first in morbidity, mortality, and cost, but the rankings for several other categories varied according to the parameter being considered.Use of a disease impact scale such as the one developed in Minnesota avoids dependence on a single parameter such as mortality or cost in making program decisions. In contrast to economic analyses of disease impact, it does not require estimates of discount rates, future rates of inflation, or salaries for homemakers, students, and children. Although the results of present calculations are only approximate, they provide a methodological framework within which correctable deficiencies in data collection methods are readily apparent. The disease impact scale is intended to be a component of a comprehensive disease surveillance system that includes measures of disease impact, the prevalence of risk factors for diseases, and the availability of health resources.

Costs and Cost Analysis↗

PubMed1989

[Magnetic resonance tomography of the locomotor system with rapid image sequences].

Rapid imaging of the musculoskeletal system with gradient-echosequences exhibits important advantages. Scanning time is reduced to 1/50 up to 1/100. Depending on TR, TE and flip-angle T1 or T2*-weighted image contrast can be achieved with comparable information to spin-echo images. Gradient-echo techniques combined with 3D-data acquisition is especially advantageous. Within a few minutes imaging of the whole interesting volume with thin contiguous slices is possible as well as secondary reconstruction of any plane. Applications of 2D- and 3D-gradient-echo-sequences for imaging pathological conditions of the spine, pelvis, upper and lower extremities, with special regard of the knee joint, will be demonstrated.

Bone Diseases↗

PubMed1997

The association of malignancy with rheumatic and connective tissue diseases.

This article reviews the associations of cancer with rheumatic diseases. Recent epidemiologic data linking the autoimmune connective tissue diseases with malignancy will be emphasized. Reports linking the occurrence of malignancy with rheumatoid arthritis, systemic lupus erythematosus, idiopathic inflammatory myopathy, scleroderma, and vasculitis are described. The effect of immunomodulating drugs in the development of malignancy is discussed. Mechanisms potentially responsible for malignant transformation in the lymphoproliferation of Sjogren's syndrome are described. The relationship of gout to cancer as well as direct effects of cancer on the musculoskeletal system is also reviewed.

Autoimmune Diseases↗

PubMed2005

3-D measurement of body tissues based on ultrasound images with 3-D spatial information.

In this study, we developed a new method to perform 3-D measurements between the recorded B-scans using the corresponding spatial location and orientation of each B-scan, without the need to create a 3-D volume. A portable ultrasound (US) scanner and an electromagnetic spatial locator attached to the US probe were used. During data collection, the US probe was moved over the region-of-interest. A small number of B-scans containing interesting anatomical information were captured from different body parts and displayed in a 3-D space with their corresponding locations recorded by the spatial locator. In the B-scan planes, the distance between any two points, as well as the angle between any two lines, could be calculated. In validation experiments, three distances and three angles of a custom-designed phantom were measured using this method. In comparison with the results measured by a micrometer, the mean error of distance measurement was -0.8 +/- 1.7 mm (-2.3 +/- 3.6%) and that of angle measurement was -0.3 +/- 2.9 degrees (-0.1 +/- 4.1%). The lengths of the first metatarsals and the angles between the first metatarsals and the middle part of the tibias of three subjects were measured in vivo using magnetic resonance imaging (MRI) and the US method by two operators before and after MRI scanning. The overall percentage differences of the length and angle measurements were 0.8 +/- 2.2% and 2.5 +/- 3.6%, respectively. The results showed that this US method had good repeatability and reproducibility (interclass correlation coefficient values > 0.75). We expect that this new method could potentially provide a quick and effective approach for the 3-D measurement of soft tissues and bones in the musculoskeletal system.

Calibration↗

PubMed1997

Effect of diaspirin crosslinked hemoglobin on systemic and regional blood circulation in pregnant rats.

Diaspirin crosslinked hemoglobin (DCLHb: Baxter Healthcare Corp., Round Lake, IL, USA) is a biochemically stable hemoglobin based solution with excellent oxygen carrying capacity. Studies have been conducted in male rats to determine the effect of DCLHb on systemic and regional blood circulation. However, the cardiovascular effect of DCLHb has not been studied in female rats. In the present study the effect of DCLHb (400 mg/kg, i.v.) was observed on systemic hemodynamic parameters and regional blood circulation in non-pregnant rats, and in 9-day pregnant and 18-day pregnant rats. DCLHb increased mean arterial pressure (MAP) and total peripheral resistance (TPR) and increased blood flow to the heart, gastrointestinal tract (GIT), mesentery & pancreas, and skin in all groups of rats. The basal blood flow to the ovaries was higher in 18-day pregnant rats when compared to non-pregnant and 9-day pregnant rats. DCLHb further increased blood flow to the ovaries of 18-day pregnant rats. It is concluded that DCLHb increases blood flow to the heart, GIT and skin as a result of redistribution of blood from the musculoskeletal system. Blood flow in female reproductive organs is not altered by DCLHb in non-pregnant rats and during mid-term pregnancy. However, in advanced stages of pregnancy DCLHb increases blood flow to the ovaries.

Animals↗

PubMed2001

Paediatric ultrasound. II. Other applications.

This article focuses on small-parts US in children. The differential diagnosis of cystic neck masses primarily includes lymphangiomas, thyroglossal duct cysts and branchial cleft cysts. Solid masses may be represented from lymphadenopathies, cervical extensions of mediastinal thymus, fibromatosis colli, rhabdomyosarcomas and neuroblastomas. Salivary gland lesions are uncommon in children. Thyroid is best evaluated by US and nuclear scintigraphy. If US shows abnormal thyroid gland, the isotopic scan may be a good complementary method to confirm the diagnosis. Normal parathyroid glands are not visualised routinely by US because of their small size. Parathyroid adenomas are unusual in paediatrics. Ultrasound can be successfully used in the differential diagnosis of the painful scrotum especially with colour flow Doppler. The hallmark of ischaemia is a completely avascular testis. In the paediatric age group, the most common application of US to the musculoskeletal system is the evaluation of the infant hip in the first 6 months of life; however, the refinement of new transducers has further improved the ability of US equipment to evaluate a variety of other musculoskeletal disorders in children, involving tendons, muscles, nerves as well as soft tissue masses. Ultrasound can be a useful screening tool in newborns suspected of having closed spinal dysraphism.

Child↗

PubMedDate not supplied

Musculoskeletal connective tissue cells with muscle: expression of muscle actin in and contraction of fibroblasts, chondrocytes, and osteoblasts.

The expression of the gene for a muscle actin in certain nonmuscle cells and the contraction of these connective tissue cells has been associated with several important physiological and pathological processes; the contraction of healing skin wounds and the contracture in Dupuytren's disease being two notable examples. Studies in recent years have shown that a much wider variety of connective tissue cells than previously considered, including cells in many of the musculoskeletal tissues, e.g., chondrocytes and osteoblasts, can express the gene for alpha-smooth muscle actin and can display contractile behavior. These findings suggest that muscle actin-enabled cell contraction may also be playing important roles in the other connective tissues comprising the musculoskeletal system, namely, tendon, ligament, meniscus, intervertebral disc, articular cartilage, and bone.

Actins↗

PubMed1994

Prevalence of, and factors associated with, musculoskeletal racing injuries of thoroughbreds.

All horses diagnosed by a commission veterinarian of the Kentucky Racing Commission as having sustained a musculoskeletal injury, defined as an obvious change in soundness immediately before, during, or after a race held between Jan 1, 1992 and May 31, 1993 were included in a study to determine the prevalence of and factors associated with racing injuries involving the musculoskeletal system of horses competing at 4 Thoroughbred racetracks in Kentucky. During the 17-month study, there were 35,484 racing starts among 7,649 horses in 3,824 official Kentucky Racing Commission races. During this period, 132 musculoskeletal racing injuries were diagnosed among 117 horses. Twenty-eight injured horses were male, 46 were geldings, and 43 were female. The prevalence of horses with racing injuries per racing start was 0.33% (117/35,484). The injuries of 51 horses were classified as catastrophic, and 66 as noncatastrophic. The prevalence of horses with catastrophic injuries per racing start was 0.14% (51/35,484). The proportion of horses with injuries of the left forelimb, sesamoid, and third metacarpal bone in the catastrophic group was significantly (P < or = 0.05) greater than those of horses in the noncatastrophic group. The proportion of horses with injuries of the superficial digital flexor tendon among those in the catastrophic group was significantly less than that of horses in the noncatastrophic group. The distance of the race was significantly shorter and the number of turns less among horses with catastrophic injuries than among horses with noncatastrophic injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

Assessment of a method to estimate muscle attachments from surface landmarks: a 3D computer graphics approach.

A method for estimating the locations of muscle origins and insertions from the measurement of surface landmarks was evaluated using two indirect accuracy tests and a three-dimensional computer graphics program. For each of four lower extremity anatomical segments, a least-squares technique was used to map the measured locations of three landmark targets to their anatomically based locations. The residual errors, obtained from the applications of the least squares, supplied the first indirect accuracy test. These residual errors were between 6 and 12 mm for the four anatomical segments when averaged over ten subjects. The second indirect accuracy test was conducted by comparing the predicted locations of end points on two adjacent segments forming a joint. Errors in aligning adjacent end points were between 12 and 29 mm for three anatomical joints when averaged over ten subjects. A three-dimensional computer graphics program was developed by the authors and demonstrated that the static testing techniques alone were insufficient to evaluate the quality of the muscle origin and insertion estimates. Any evaluation of muscle lengths, velocities and lines-of-action from surface landmarks should examine the estimates made from motion data, and should address both the ability of the model to fit the subjects as well as model's ability to represent the geometry of the musculoskeletal system.

Anthropometry↗

PubMed2004

Active stiffness of the ankle in response to inertial and elastic loads.

Effective stiffness of the musculoskeletal system was examined as a function of the characteristics of an external load. Thirteen healthy subjects provided active contraction of the ankle plantarflexion musculature in a neutral ankle posture to support an external load. Musculoskeletal stiffness was computed from kinetic data recorded in response to dorsiflexion/plantarflexion perturbations. Ankle dynamics were recorded while supporting external loads of 19 and 38 kg with and without antagonistic co-contraction. External loads were applied using pure gravitational mass. In separate trials external loads were applied from stretch of steel springs in parallel with the plantarflexion musculature that also provided added parallel stiffness to the system. Adding external stiffness of 4.9 and 8.1 kN/m surprisingly failed to significantly change the stiffness of the ankle-plus-spring system. This suggests contributions from intrinsic muscle stiffness and reflex stiffness declined in response to added external stiffness. This could not be explained by load magnitudes, ankle postures, or co-activation as these were similar between the inertial and elastic loading conditions. However, non-linear parametric analyses suggest mean intrinsic stiffness of 35.5 kN/m and reflex gain of 11.6 kN/m with a constant reflex delay of 70 ms accurately described the empirical results. The phase response between the mechanical dynamics of the musculoskeletal system and delayed neuromotor feedback combine to provide robust control of system behavior.

Acceleration↗

PubMed2006

High-field MRI.

High-field MRI is moving rapidly from the research realm to clinical use. This modality has intrinsic advantages in signal to noise ratio, which allows images that have im-proved resolution, are obtained faster, or have less noise. Perhaps most importantly these scanners will allow functional imaging to become a reality in the musculoskeletal system. Care must be used in protocols because of the energy deposition and worsened artifacts at higher fields.

Artifacts↗

PubMed2001

[Overuse and trauma in sports--clinical symptoms in the context of modern imaging techniques].

New insights in the fields of pathology and diagnostic radiology of sports injuries show that the borders between overuse syndromes and trauma are blurred. Techniques of diagnostic imaging are increasingly important for an objective documentation of morphologic changes of the musculoskeletal system. Typical sports-related syndromes exist and their clinical diagnosis is not always easy because pain cannot be located exactly.

Athletic Injuries↗

PubMed2000

Congenital malformations in Shimla.

Congenital malformations were studied over a period of five years in 10,100 consecutive births including still births at Indira Gandhi Medical College, Shimla. Out of these, 180 babies had one or the other congenital malformations and the overall incidence was 1.78%. Amongst the 311 still born babies 47 had congenital malformations indicating that the incidence of congenital malformations was much higher in still born babies (15.1%) as compared to the live born babies (1.3%). The malformations involving the central nervous system were the commonest (40%) followed by musculoskeletal system (23.8%) while genitourinary system malformations were the least common and accounted for 3.8% of the cases. Incidence of congenital malformations was the highest in mothers over 35 years of age and gravida four and more. The incidence was 2.8% in both the groups; the incidence of congenital malformation was more in babies weighing < 2500 gms and was 2.6%.

Congenital Abnormalities↗

PubMed2005

Angina pectoris with a normal coronary angiogram.

Angina in the setting of a normal angiogram (NOCAD) occurs in 20-30% of patients undergoing coronary angiography. The etiologies of NOCAD can be anatomically classified into three groups: epicardial disease, coronary microvascular dysfunction, and noncoronary disease. Epicardial disease resulting in NOCAD includes endothelial dysfunction, coronary artery spasm, and coronary artery bridging. Microvascular dysfunction may be secondary to hypertension, cardiomyopathy, infiltrative disease, valvular disease, or idiopathic. Noncoronary artery disease states involving other organs systems such as the pulmonary, gastrointestinal, or musculoskeletal systems can also result in NOCAD. This review focuses on the coronary etiologies of NOCAD. The pathophysiology of disease is discussed as well as a systematic diagnostic strategy. Potential therapeutic options and prognosis are also reviewed.

Clinical Trials as Topic↗

PubMed2003

Theories of bipedal walking: an odyssey.

In this paper six theories of bipedal walking, and the evidence in support of the theories, are reviewed. They include: evolution, minimising energy consumption, maturation in children, central pattern generators, linking control and effect, and robots on two legs. Specifically, the six theories posit that: (1) bipedalism is the fundamental evolutionary adaptation that sets hominids--and therefore humans--apart from other primates; (2) locomotion is the translation of the centre of gravity along a pathway requiring the least expenditure of energy; (3) when a young child takes its first few halting steps, his or her biomechanical strategy is to minimise the risk of falling; (4) a dedicated network of interneurons in the spinal cord generates the rhythm and cyclic pattern of electromyographic signals that give rise to bipedal gait; (5) bipedal locomotion is generated through global entrainment of the neural system on the one hand, and the musculoskeletal system plus environment on the other; and (6) powered dynamic gait in a bipedal robot can be realised only through a strategy which is based on stability and real-time feedback control. The published record suggests that each of the theories has some measure of support. However, it is important to note that there are other important theories of locomotion which have not been covered in this review. Despite such omissions, this odyssey has explored the wide spectrum of bipedal walking, from its origins through to the integration of the nervous, muscular and skeletal systems.

Adult↗

PubMed1999

Antinuclear antibodies: presence and specificity in autoimmune connective tissue disease in the dog.

Autoimmune connective tissue disease in both animals and humans present as multi-systemic disorders. Clinical signs referable to joints, musculoskeletal system and Dermatopathies are present. Autoantibody production is a regular feature of systemic autoimmune disease and these antibodies have diagnostic value in both human and veterinary medicine. In this study, we demonstrate that many of the commonly used diagnostic techniques developed for use with human patients may also be adapted for use in dogs. However, in some instances, 'canine specific' autoantibodies, distinct from analogous human antibodies may be detected in sera from dogs with a diagnosis of autoimmune disease. This finding indicates that dogs may develop 'dog-specific' autoimmune connective tissue disease.

Animals↗