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At least 793 records · Page 44Linked to original sources

PubMed2002

Oncologic uses of the retrograde femoral nail.

Destructive lesions about the distal femur represent difficult treatment situations. Patients who present with impending or pathologic fractures require a method of fixation that provides adequate stabilization to allow for early, pain-free ambulation. Other considerations include restoration of functional range of motion, low perioperative morbidity and mortality risk, and minimal soft tissue dissection. Eleven patients with 12 pathologic or impending fractures of the distal femur who were treated with retrograde intramedullary nailing with and without polymethylmethacrylate augmentation were retrospectively reviewed. Followup averaged 17 months. Postoperative range of motion averaged 94 degrees flexion, 90% of patients reported no or modest pain, 81% were functioning with no restrictions or recreational restrictions only, and all patients were enthusiastic or satisfied with their surgical outcome. There were no perioperative mortalities, but one patient had 2 cm shortening secondary to broken distal locking screws and asymptomatic nail protrusion into the knee. Using the system for functional evaluation of reconstructive treatment of tumors of the musculoskeletal system, the average score for each patient was 25 (range, 18-30) or 83% (60%-100%) of the maximum score. The retrograde nail was an easy and successful method of fixation in this clinical setting.

Adult↗

PubMed1989

Sjögren's syndrome beyond the eye.

Sjögren's syndrome is a common systemic disease with major clinical manifestations in the eye, mouth and musculoskeletal system. The major clinical presentations of Sjögren's syndrome are reviewed with emphasis on diagnostic criteria, laboratory features, complications and treatment.

History, 19th Century↗

PubMed1993

Fibromyalgia--a new cause for disability pension.

Fibromyalgia is a condition under dispute. Accepted by some as a major step forward in understanding some of the patients with widespread muscular pain, looked upon as a confusing side step by others. In 1988 fibromyalgia was by far the most frequent single diagnosis as a reason for disability pension in Norway. Disability statistics however show big differences between counties. Two neighbouring counties had among the lowest and the highest incidence of disability pensioners with the diagnosis fibromyalgia. New pensioners with fibromyalgia and some closely related diagnoses have been studied during the year 1988 by means of reading the insurance records. It became apparent that the difference between the two counties with respect to the incidence of fibromyalgia as a cause of disability pension could be explained by differences in diagnostic setting by the doctors and difference in the assessment from the insurance system, rather than real differences in morbidity pattern. Complaints from the musculoskeletal system is frequent and increasing in the population both as a reason for sick leave and disability pension. Whether this complicated and challenging situation is made more easy to handle by defining a subgroup of those persons as having "fibromyalgia" is questioned.

Adult↗

PubMed2006

Scoliosis in the child with cerebral palsy.

Scoliosis is common in children with cerebral palsy. The incidence and curve pattern depend on the degree of neurologic involvement. These children carry a higher risk of complications because of the increased presence of associated medical comorbidities. Accordingly, a careful preoperative evaluation is required that should involve assessment of the patient's pulmonary, nutritional, gastrointestinal, and neurologic systems as well as a thorough evaluation of the spine and musculoskeletal system. Children with progressive curves >40 degrees to 50 degrees are candidates for spinal fusion, especially when the deformity interferes with sitting or is unresponsive to bracing. The goal of surgery is to obtain a stable, balanced, and painless spinal fusion. Although posterior spinal fusion with multisegmental fixation is the most common technique, others, such as anterior release and/or fusion or combined procedures, are now considered. In patients with significant pelvic obliquity or who are at risk of developing pelvic obliquity, instrumentation should extend to the pelvis, particularly in the nonambulatory child.

Cerebral Palsy↗

PubMed2003

[Massive frozen allografts for skeletal reconstruction: styles and affecting factors of bone union].

OBJECTIVE: To investigate the styles and affecting factors of bone union after massive frozen allografting for skeletal reconstruction owing to excision of bone tumor. METHODS: From 1992 to 1999, 85 patients suffering from bone malignant tumor were given the excision of large bone segment and treated with allografting in different methods of operation: large bone allografts with condylar articular surface in 16 cases, osteoarticular allografts in 57 cases, bone allografts in combination with prosthetic replacement of hip in 9 cases, and prosthetic replacement of knee in 3 cases. The average follow-up was 2 years and 9 months. The union time and styles of host-donor junction were determined by X-ray characters, and the results of operations were assessed according to Enneking's functional evaluation system of reconstructive procedures after surgical treatment of tumors for the musculoskeletal system. RESULTS: There were 4 kinds of basic bone union styles by the X-ray characters, there were no significant difference in the time span of bone union after fixation with different methods. Of the 85 fresh-frozen allografting procedures, more than 80% of the patients were treated with interlocked intramedullary nail and allograft-prosthesis combination, and the overall result was excellent and good. Sufficient blood supply was important for host-donor junction healing, but the function of immune response was uncertain. CONCLUSION: There were different styles of bone union after massive allografting. The recommended operative methods for massive allografts are stable internal fixation, sufficient blood supply, soft tissue repair and periosteal flap coverage.

Adolescent↗

PubMed2005

Mortality and morbidity among bridge and tunnel construction workers who worked long hours and long days constructing the Great Belt Fixed Link.

OBJECTIVES: This study aimed at estimating the mortality and morbidity of hospital treatment among bridge and tunnel workers who worked round the clock, long hours, and long weeks to construct the Great Belt Fixed Link. METHODS: A cohort of all Danish workers in the construction industry was followed for death and first hospitalization and outpatient or emergency ward treatment over 6 years. Standardized mortality and morbidity ratios (SMR) were calculated for selected diagnoses, and 5123 bridge and tunnel construction workers were compared with all 109 383 Danish construction workers. RESULTS: The comparison showed an overall SMR of 124 with a 95% confidence interval (95% CI) of 97-155. For infectious diseases and intestinal infectious diseases, the corresponding values were 156 (95% CI 132-184) and 167 (95% CI 117-230), respectively. For diseases of the nervous system, it was 138 (95% CI 118-160), and including nerve, nerve root and plexus disorders it was 135 (95% CI 104-171), for instance, mononeuropathies of the upper limbs (SMR 136, 95% CI 101-180). The SMR was 139 (95% CI 126-153) for circulatory diseases, 157 (95% CI 130-189) for ischemic heart disease, 129 (95% CI 114-146) for diseases of the respiratory system, 124 (95% CI 114-135) for diseases of the digestive system, and 115 (95% CI 108-123) for diseases of the musculoskeletal system and connective tissue, including other intervertebral disc disorders (than cervical) (SMR 130, 95% CI 109-154). CONCLUSIONS: Bridge and tunnel workers who work round the clock, long hours, and long weeks have a mortality rate that is as high as that of other construction workers, and they are treated more often in hospitals.

Adult↗

PubMed1996

Body mass index and disability pension in middle-aged men--non-linear relations.

BACKGROUND: Obesity has, in a number of studies, been found to correlate to disability and mortality, primarily due to diseases of the circulatory and musculoskeletal systems. In addition, an excess mortality among underweight subjects has been observed in previous studies. METHODS: Five complete birth-year cohorts (1926-1930) of male residents in Malmö (n = 7697) were invited to the survey at the Department of Preventive Medicine, Malmö General Hospital, and 5926 (77%) attended with complete data. Each subject was followed from inclusion, defined by the date of examination, until the end of the calendar year when he turned 58, a total study period of approximately 11 years. Data on about 300 questionnaire items and laboratory tests were determined at the health survey visit. Nationwide Swedish data registers were used for surveillance. RESULTS: Of the participants, 4.7% were underweight, 37.7% overweight, 7.3% obese and 50.3% normal weight; 849 (14.3%) had been granted disability pension at the end of follow-up, 717 after screening. After adjustment for smoking there was a J-shaped relation between body mass index (BMI) and incidence of disability pension, the relative risk ( with the normal group as reference) among underweight men being 1.9. For the overweight subjects it was 1.3 and for the obese 2.8, all differences were significant. Disease of the musculoskeletal and circulatory systems and mental disorders accounted for 67.2% of all main diagnoses resulting in disability pensions during follow-up. A total of 377 (6.4%) men died during follow-up. Diseases of the circulatory system, neoplasms, injury/poisoning and diseases of the respiratory system accounted for 91.8% of the deaths. CONCLUSIONS: Both underweight, overweight and obesity were related to risk of disability pension, with a J-shaped risk relationship.

Body Mass Index↗

PubMed2002

Aluminum: impacts and disease.

Aluminum is the most widely distributed metal in the environment and is extensively used in modern daily life. Aluminum enters into the body from the environment and from diet and medication. However, there is no known physiological role for aluminum within the body and hence this metal may produce adverse physiological effects. The impact of aluminum on neural tissues is well reported but studies on extraneural tissues are not well summarized. In this review, the impacts of aluminum on humans and its impact on major physiological systems are summarized and discussed. The neuropathologies associated with high brain aluminum levels, including structural, biochemical, and neurobehavioral changes, have been summarized. In addition, the impact of aluminum on the musculoskeletal system, respiratory system, cardiovascular system, hepatobiliary system, endocrine system, urinary system, and reproductive system are discussed.

Aluminum↗

PubMed1999

The risks of exercise.

Patients with end-stage renal disease (ESRD) can benefit from exercise. At a minimum, progressive deconditioning will be prevented and cardiovascular and musculoskeletal status quo maintained, but it is also possible that physical functioning will be improved and mortality reduced. The risks of exercise must be assessed along with potential benefits. The most serious inherent risk of exercise in this population is a cardiac event, but the most common injuries sustained are to the musculoskeletal system. The exercise prescription must include measures to minimize both cardiovascular and musculoskeletal risk. These include provision of a prolonged warm-up and exercise adaptation period and time allowance for adequate cool-down. If these guidelines are followed and the exercise is begun at a low to moderate intensity, the associated risk to the ESRD patients should be minimal. For most ESRD patients, the risk benefit ratio will fall in favor of exercise, with the majority of patients exposed to greater risk by not exercising. Increased physical activity should be fostered in ways so that it becomes a routine part of the medical therapy and the mindset of the patient who then strives for self-improvement.

Cardiovascular Diseases↗

PubMed2004

[Uric acid, a neglected molecule--the value of imaging].

Imaging plays a key role in two longterm effects of hyperuricemia: those on the urinary tract and on the skeletal system. This overview concentrates on the diagnosis of urinary stones and of musculoskeletal gout. Urinary stones are negative on radiography, i.e., they cannot be differentiated from the surrounding tissues, and even at intravenous urography only non specific filling defects are shown that may be hard to differentiate from blood clots and papillary necrosis whereas computed tomography without a contrast agent is highly sensitive in detecting all types of stones whether negative or positive at radiography. Gout of the musculoskeletal system usually manifests as an acute gouty arthritis after a long-standing asymptomatic hyperuricemia. An intercritical phase may follow before new acute attacks and--in up to 50%--chronic gout develop. During acute gouty arthritis imaging is non-specific. The distribution pattern, the relation of soft tissue changes and osteolytic paraarticular changes, calcifications and the lack of osteoporosis are a typical, nearly pathognomonic constellation of chronic tophaceous gout. In selected cases CT or MRI may add critical local information.

Arthritis, Gouty↗

PubMedDate not supplied

Correlation analysis of proprioceptive acuity in ipsilateral position-matching and velocity-discrimination.

In order to plan and control movements the central nervous system (CNS) needs to continuously keep track of the state of the musculoskeletal system. Therefore the CNS constantly uses sensory input from mechanoreceptors in muscles, joints and skin to update information about body configuration on different levels of the CNS. On the conscious level, such representations constitute proprioception. Different tests for assessment of proprioceptive acuity have been described. However, it is unclear if the proprioceptive acuity measurements in these tests correlate within subjects. By using both uni- and multivariate analysis we compared proprioceptive acuity in different variants of ipsilateral active and passive limb position-matching and ipsilateral passive limb movement velocity-discrimination in a group of healthy subjects. The analysis of the position-matching data revealed a higher acuity of matching for active movements in comparison to passive ones. The acuity of matching was negatively correlated to movement extent. There was a lack of correlation between proprioceptive acuity measurements in position-matching and velocity-discrimination.

Adult↗

PubMed2000

HMG-CoA reductase inhibitors and myotoxicity.

The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors specifically inhibit HMG-CoA reductase in the liver, thereby inhibiting the biosynthesis of cholesterol. These drugs significantly reduce plasma cholesterol level and long term treatment reduces morbidity and mortality associated with coronary heart disease. The tolerability of these drugs during long term administration is an important issue. Adverse reactions involving skeletal muscle are not uncommon, and sometimes serious adverse reactions involving skeletal muscle such as myopathy and rhabdomyolysis may occur, requiring discontinuation of the drug. Occasionally, arthralgia, alone or in association with myalgia, has been reported. In this article we review scientific data provided via Medline, adverse drug reaction case reports from the Swedish Drug Information System (SWEDIS) and the World Health Organization's International Drug Information System (INTDIS) database, focusing on HMG-CoA reductase inhibitor-related musculoskeletal system events. Cytochrome P450 (CYP) 3A4 is the main isoenzyme involved in the metabolic transformation of HMG-CoA reductase inhibitors. Individuals with both low hepatic and low gastrointestinal tract levels of CYP3A4 expression may be at in increased risk of myotoxicity due to potentially higher HMG-CoA reductase inhibitor plasma concentrations. The reported incidence of myotoxic reactions in patients treated with this drug class varies from 1 to 7% and varies between different agents. The risk of these serious adverse reactions is dose-dependent and may increase when HMG-CoA reductase inhibitors are prescribed concomitantly with drugs that inhibit their metabolism, such as itraconazole, cyclosporin, erythromycin and nefazodone. Electrolyte disturbances, infections, major trauma, hypoxia as well as drugs of abuse may increase the risk of myotoxicity. It is important that the potentially serious adverse reactions are recognised and correctly diagnosed so that the HMG-CoA reductase inhibitor may at once be withdrawn to prevent further muscular damage.

Animals↗

PubMed2004

[Pulmonary involvement in collagen tissue diseases].

Collagen tissue diseases are multisystem and heterogeneous group disease mediated inflammatory disorders. The pulmonary manifestations is more common and all elements of the lung are involved. However, symptoms of the respiratory system may be masked by exercise limitation due to involvement of the musculoskeletal system. The involvement may be subclinical or determined fulminant and life-threatening dimension. In this review, the pulmonary involvement of the more common collagen tissue diseases are reviewed.

Collagen Diseases↗

PubMed2000

Intramuscular pressure of the infra- and supraspinatus muscles in relation to hand load and arm posture.

In work engaging the upper extremities, the musculoskeletal system of the shoulder is sometimes exposed to prolonged excessive load, leading to musculoskeletal disorders of the shoulder. One way of reducing work-related shoulder disorders is to establish guidelines for working postures. The purpose of this study was to identify harmful working positions, by performing a comprehensive survey of the intramuscular pressure (IMP) in the infra- and supraspinatus muscles in relation to different arm positions and external loads. Ten healthy males participated, and the IMP in the infra- and supraspinatus muscles was studied in a total of 112 combinations of arm positions and hand loads at levels that occur frequently in industrial work. High-precision spatial recordings were accomplished with a three-dimensional motion-analysis system, and the IMP was measured using the microcapillary infusion technique. The mean IMP of the infraspinatus muscle as well as that of the supraspinatus muscle increased continuously from a resting pressure at 0 degrees of upper arm elevation to a maximal pressure at 90 degrees of upper arm elevation, for all elevation planes. The mean IMP of the supraspinatus muscle appeared to be more dependent upon the elevation plane and less dependent upon the hand load, compared to the infraspinatus muscle. Even during only moderate arm elevation, the mean IMP of the infra- and supraspinatus muscles, presented here in polar diagrams, had already exceeded the levels of reduced recovery from local muscle fatigue and blood flow impairment. The elevation angle and the hand load primarily influence the development of IMP in the infra- and supraspinatus muscles.

Adult↗

PubMed2006

Investigation of in vivo 6DOF total knee arthoplasty kinematics using a dual orthogonal fluoroscopic system.

Fluoroscopic techniques have been recently used to detect in vivo knee joint kinematics. This article presents a technique that uses two fluoroscopes to form a dual orthogonal fluoroscopic system for accurately measuring in vivo 6DOF total knee arthoplasty (TKA) kinematics. The system was rigorously validated and used to investigate in vivo kinematics of 12 patients after cruciate-retaining TKA. In a repeatability study, the pose of two different TKA components was reproduced with standard deviations (SD) of 0.17 mm and 0.57 degrees about all three axes. In an accuracy study, the reproduced component positions were compared to the known component positions. Position and rotation mean errors were all within 0.11 mm and 0.24 degrees, with SD within 0.11 mm and 0.48 degrees, respectively. The results of this study show that the matching process of the imaging system is able to accurately reproduce the spatial positions and orientations of both the femoral and tibial components. For CR TKA patients, a consistent anterior femoral translation was observed with flexion through 45 degrees of flexion, and thereafter, the femur translated posteriorly with further flexion. The medial-lateral translation was measured to be less than 2 mm throughout the entire flexion range. Internal tibial rotation steadily increased through maximum flexion by approximately 6 degrees. Varus rotation was also measured with flexion but had a mean magnitude less than 2.0 degrees. In conclusion, the dual orthogonal fluoroscopic system accurately detects TKA kinematics and is applicable towards other joints of the musculoskeletal system, including the wrist, elbow, shoulder, ankle, and spine.

Arthroplasty, Replacement, Knee↗

PubMed2003

Neoplasia of reptiles with an emphasis on lizards.

Neoplasia is an important form of disease in saurians. According to previous reviews, the organs most commonly affected by neoplastic disease are the hematopoeitic system, the hepatic system, and the skin. However, our own review suggests that tumors of the musculoskeletal system are also prevalent. Neoplasia should be considered as a significant differential diagnosis when presented with a lizard that has nonspecific clinical signs. The previously described diagnostic techniques should be applied to obtain a rapid and accurate definitive diagnosis. As more cases of neoplastic disease in saurians are reported, a comprehensive study of the data, including detailed examination of environmental factors, may bring forth causative agents. According to Withrow, cancer is one of the leading killers of pet animals, and thus has become a real concern for dog and cat owners [67]. Given that most people will either know someone with cancer or experience cancer first hand, the general public is more educated than ever on neoplastic disorders. As veterinarians, it is important to become familiar with the neoplastic diseases in all species, and to be educated in tumor pathophysiology and treatment. The public expects veterinarians to be dependable sources of knowledge and compassion.

Animals↗

PubMed1976

Orthopedic manpower.

Key statistical information regarding Orthopedic Manpower is present to make orthopedists aware of the detailed information that is currently available. It is clear there is still insufficient data to justify radically altering the numbers or types of practices. Until the scope of orthopedic practice is more clearly defined and generally accepted (by orthopedists, other physicians, health professionals and the public) we must continue to monitor our activities and make adjustments through evolutionary changes rather than revolutionary regulations. Quite clearly there are segments of our country that are orthopedically underserved. Thus, it is vital that we seek new methods to encourage orthopedists to settle in these areas. Clearly, the simple production of more orthopedists in the traditional model will not answer the geographic maldistribution. With the tremendous scope of problems cared for by orthopedists, there does not appear to be an oversupply; however, we are headed in that direction. If we continue to rate operative procedures as the most significant and satisfying aspect of the practice, we certainly have enough, but they are not spread across the country in a uniform manner. Significant increases in numbers will be necessary if the orthopedist is to assume the role of general practitioner of the musculoskeletal system as well as a specialist for diagnosing and treating the more complicated musculoskeletal problems (whether by medical-surgical or physical-medical modalities). Should this be the case adjustments must be made in the selection process of orthopedic residents, in training programs, as well as estimates of the numbers of such specialists necessary for the future.

Allied Health Personnel↗

PubMedDate not supplied

MR findings of Erdheim-Chester disease.

Lipoid granulomatosis (Erdheim-Chester disease) is a rare but distinct form of histiocytosis. This disease has characteristic radiologic findings involving the musculoskeletal system that are critical to the diagnosis: symmetric sclerosis of the metaphysis and diaphysis of long bones with relative sparing of the epiphysis as depicted on conventional radiography. However, it is a systemic disease that involves multiple organ systems. This pictorial essay is of a single patient imaged over multiple years, using various pulse sequences with both low and high field strength MR scanners. It depicts many of the characteristic findings encountered in this rare systemic disorder.

Diagnosis, Differential↗