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At least 19 recordsLinked to original sources
PubMed2002

Suppressed cutaneous endothelial vascular control and hemodynamic changes in paretic extremities with edema in the extremities of patients with hemiplegia.

OBJECTIVE: To investigate peripheral circulatory function and its underlying mechanisms in the paretic upper extremity after a stroke. DESIGN: Case-control study. SETTING: A department of physical medicine and rehabilitation in Taiwan. PARTICIPANTS: A total of 53 hemiplegic patients (28 men, 25 women; mean age +/- standard deviation; 58.2+/-3.8y) were studied. Subjects were divided into edema and nonedema groups. The edema group included 29 hemiplegic patients with edematous paretic upper extremities. Twenty-four hemiplegic patients in the nonedema group did not suffer from limb edema in the paretic upper extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cutaneous microvascular perfusion responses to 3 grade levels of iontophoretically applied 1% acetylcholine (ACh), 1% ACh plus 1% N(G)-monomethyl-L-arginine (L-NMMA), and 1% sodium nitroprusside (SNP) in the skin of subjects' forearms were determined by laser Doppler perfusion measurements. Moreover, hemodynamic characteristics in the arterial and venous vessels were measured by impedance plethysmography. RESULTS: Resting arterial inflow and venous capacity, tone, and outflow in paretic extremities did not significantly differ from nonparetic extremities, but the hyperemic arterial inflow was lower in paretic extremities than in nonparetic extremities, and paretic extremities were associated with lower ACh- and ACh plus L-NMMA-induced cutaneous perfusions than nonparetic extremities. ACh-induced cutaneous perfusions also decreased much more significantly in edematous paretic extremities than in nonedematous paretic extremities, and skin vascular responses to SNP do not differ significantly between paretic and nonparetic extremities. CONCLUSION: Cutaneous microcirculatory function in the paretic upper extremity after stroke may be impaired. The impairment may occur because of decreased endothelium-dependent dilation in skin vasculature. Dysfunction in cutaneous microcirculation tends to be more pronounced in the edematous than in the nonedematous extremities.

Adult↗
PubMed1985

[A roentgenographical study on the aging process of alignment of the lower extremities in children--with special reference to pain in the lower extremity].

To date, detailed reports are not available in large number concerning the alignment of lower extremities of children. Moreover, those already published are primarily concerned only with normal children, failing to make a sound comparison of lower extremity alignment between normal children and children with complaints about lower extremity alignment. Following is the summary of extensive research the author has done by comparing statistical data obtained--such as measurements of condylar distance, malleolar distance, and alignments of lower extremities--from 269 cases of normal children (538 lower extremities), from 2 years to 15 years, and 173 cases of children with pain (215 lower extremities), from 3 years to 15 years. Most of the children aged five years and older, whose main complaint is pain in their lower extremities, were found to show significant variations in the alignment of their lower extremities and were compared to normal children. When the intercondylar distance is greater than 10 mm, it is imperative to carefully investigate the alignment of the patient's lower extremities, because the pain is almost always found due to the malalignment. Bow legs and knock knees are not only deformity but also frequently accompanied by pain. Therefore, Lanz's method is most useful to evaluate bow legs and knock knees.

Adolescent↗
PubMed1994

Mangled extremity severity score: an accurate guide to treatment of the severely injured upper extremity.

The mangled extremity severity score (MESS) is a scoring system that can be applied to mangled extremities and help one determine which mangled limbs will eventually come to amputation. The MESS is a graduated grading system based on skeletal and soft tissue injury, shock, ischemia, and age. The records of 37 patients having sustained 43 open fractures or mangled upper extremity injuries, seen and treated at the University of New Mexico's Regional Trauma Center between April 1987 and September 1990, have been reviewed. All nine extremity injuries with a MESS of greater than or equal to seven were amputated, and 34 of 34 with a MESS of less than seven were salvaged. Nine Grade IIIC and six mangled extremities were identified in our study. Five of these Grade IIIC and four of the mangled extremities with a MESS of greater than or equal to seven were amputated. All Grade IIIC or mangled extremities with a MESS of less than seven were salvaged. In conclusion, the MESS is an early and accurate predictor for identifying the extremities that may be best treated by amputation.

Adult↗
PubMed1996

Extremity and non-extremity high-grade osteosarcoma -- the Norwegian Radium Hospital experience during the modern chemotherapy era.

Of 103 patients with high-grade osteosarcoma, 27% had tumours localized outside the extremities. Non-extremity patients were significantly older at diagnosis than patients with extremity tumours (median 38 vs. 17 years). More than 90% of patients with extremity tumours received adequate treatment (aggressive chemotherapy plus at least marginal surgery), compared with only 25% of patients with non-extremity tumours. Failure of adequate treatment was due to inoperable tumour, intralesional surgery and age preventing aggressive chemotherapy. There was a highly significant difference in both local tumour control and overall survival, both favouring patients with extremity tumours. Within the extremity tumour group, patients who were treated in prospective multicentre trials had a significantly better outcome than non-trial patients. Our results show that the fraction of patients with high-grade tumours that fall outside trials designed for 'classical osteosarcoma' may be larger than is usually acknowledged, and that the results reported for the classical group are by no means representative of the whole patient population. Improved and new treatment approaches are needed for patients with non-extremity tumours, particularly in the older age groups.

Adolescent↗
PubMed2002

Affective habituation: subliminal exposure to extreme stimuli decreases their extremity.

Following a functional perspective on evaluation, the authors hypothesized that subliminal exposure to extreme stimuli (e.g., extremely negative or positive words) would lead these stimuli to be perceived as less extreme. This process--affective habituation--was tested in 4 experiments. In Experiment 1, participants were subliminally exposed to extremely positive and extremely negative words. In a subsequent explicit-judgment task, these words were rated as less extreme than extreme words that had not been presented. In Experiment 2, these results were replicated with an implicit evaluation measure. In Experiments 3 and 4, subliminal exposure to extreme positive and negative words made the words "behave" as words that are only moderately positive or negative. Several implications are discussed.

Adaptation, Psychological↗
PubMed1985

The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity.

The severely mangled extremity presents a challenge in appropriate surgical management. Very few objective data were found about this problem. To clarify the situation, criteria for a "mangled extremity' were defined, a multidisciplined approach employed, and a retrospective graduated grading system developed. Sixty consecutive trauma patients with severely injured extremities during the past 3 years were reviewed. Seventeen patients fit the category of Mangled Extremity Syndrome (M.E.S.). Injuries were retrospectively classified using a graduated grading system directed at four major tissue systems of the extremity involved (integument, nerve, artery, and bone). Additional scoring items were included to define the significance of trauma sustained outside the extremities. Patients who ultimately came to amputation could have been identified preoperatively at initial emergency evaluation utilizing this graduated grading system. Retrospective data suggest that a Mangled Extremity Syndrome Index (M.E.S.I.) of 20 is the dividing line below which functional limb salvage can be expected and above which limb salvage is improbable. Prospective application of this system, as well as an organized multidisciplined approach, could be useful in the identification of functionally retrievable versus probably irretrievable extremities, thus identifying and helping define the indications for amputation. The grading system criteria and results in these 17 patients form the basis of this report.

Adult↗
PubMedDate not supplied

Two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis in the lower extremities without clinical symptoms or signs in the upper extremities.

BACKGROUND CONTEXT: There is no report in the literature of two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis/paralysis exclusively in the bilateral lower extremities. PURPOSE: To identify the clinical characteristics of specific myelopathy resulting from C6-C7 disc herniation through a case with spastic paresis in the lower extremities without upper extremities symptoms due to separate disc herniation in the cervical and thoracic spine, which was surgically removed in two stages. STUDY DESIGN/SETTING: A case report. METHODS: A 48-year-old man developed a gait disturbance as well as weakness and numbness in the lower extremities. Thoracic magnetic resonance imaging (MRI) showed a T11-T12 disc herniation, which was removed under the surgical microscope through a minimally invasive posterior approach. He improved, but 2 months after surgery developed recurrent numbness and spasticity. On this occasion, no evidence of recurrence of the thoracic disc herniation could be identified, but cervical MRI demonstrated a compressed spinal cord at the C6-C7 level. The patient had no neurological findings in the upper extremities. The herniated disc at C6-C7 was removed under the surgical microscope with laminoplasty. RESULTS: The symptoms gradually improved after surgery. At the present time, 2 years and 9 months after the initial operation, the patient had a stable gait and was able to work. CONCLUSIONS: Our experience suggests that in the diagnosis of patients with spastic paresis and sensory disturbances in the lower extremities, spinal cord compression should be explored by imaging studies not only in the thoracic spine but also in the cervical spine, especially at the C6-C7 level, even if the symptoms and abnormal neurological findings are absent in the upper extremities.

Arm↗
PubMed2006

Loading modalities and bone structures at nonweight-bearing upper extremity and weight-bearing lower extremity: a pQCT study of adult female athletes.

This cross-sectional study of adult female athletes assessed whether the apparent loading-related differences in bone structure are primarily associated with the loading type or the muscle performance-related joint moments. Several structural variables at shaft sites of the tibia, radius and humerus, and distal sites of the tibia and radius were measured with peripheral quantitative computed tomography (pQCT) among 113 female national level athletes (representing hurdling, volleyball, soccer, racket-sports and swimming) and their 30 nonathletic referents. For the weight-bearing lower extremities, the loading modalities of the above sports were classified into high-impact (hurdling, volleyball), odd-impact (soccer, racket-sports) and repetitive, nonimpact (swimming) loadings; and for the nonweight-bearing upper extremities into high magnitude (functional weightlifting in hurdling and soccer), impact (volleyball, racket-sports) and repetitive, nonimpact (swimming) loadings. As expected, athletes' bone mass was substantially higher at loaded bone sites compared with the nonathletic referents, but more pertinently to the locomotive perspective, the loading-induced additional bone mass seemed to be used to build mechanically strong and appropriate bone structures. Compared with controls, the weight-bearing bone structures of female athletes (swimmers excluded) were characterized by larger diaphysis, thicker cortices and somewhat denser trabecular bone. The athletes' bones at the nonweight-bearing upper extremity were generally larger in cross-sectional area. The estimated indices of joint moment (muscle force x estimated lever arm) were explained from 29% to 50%, and the loading modalities from 8% to 25%, of the variance in most bone variables (P < 0.05) of the tibia (shaft and distal site). In contrast to the weight-bearing tibia, only the estimated joint moment was positively associated (P < 0.05) with the structural characteristics of the radius and humerus, accounting for 6% to 26% of the variance in bone variables of the shafts of these bones. Such association was not observed at the distal radius. In conclusion, at the weight-bearing lower extremity, the strong bone structure of the female athletes was attributable to muscle performance-related estimated joint moments and impact loading modality. At the shaft sites of the nonweight-bearing upper extremity, the strong bone structure was mainly attributable to the estimated joint moments. Thus, different loading history and other features of loading seemed to govern the skeletal adaptation at the upper and lower extremity.

Absorptiometry, Photon↗
PubMed2004

Lower extremity muscle perforator flaps for lower extremity reconstruction.

A true muscle perforator flap is distinguished by the requisite intramuscular dissection of its musculocutaneous perforator to capture the same musculocutaneous territory but with total exclusion of the muscle, and thereby results in minimal functional impairment. Adhering to this definition, several lower extremity donor sites now are available, each with specific attributes especially useful for consideration in the treatment of lower extremity defects. In this author's experience over the past two decades, 20 lower extremity muscle perforator flaps using multiple donor sites proved advantageous for lower extremity coverage problems as either a local pedicled flap or as a microsurgical tissue transfer. Significant complications occurred in 30 percent of flaps (six of 20) in that further intervention was required. Venous insufficiency and bulkiness were found to be the major inherent shortcomings. However, giant flaps, lengthy and large-caliber vascular pedicles, and the possibility for combined flaps were important assets. The choice of a lower extremity muscle perforator flap for lower extremity reconstruction limited the surgical intervention and morbidity to a single body region.

Female↗
PubMed1996

Lower extremity injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness.

OBJECTIVE: Two components of flexibility, muscle tightness, and ligamentous laxity in college athletes were studied to determine whether these factors were associated with the incidence of lower extremity injuries. DESIGN: Prospective cohort study. SETTING: College athletic department. PARTICIPANTS: 201 college athletes. OUTCOME MEASURES: College men and women athletes were tested for ligamentous laxity with the Beighton scale and for muscle tightness with a new scale based on the tightness of the iliopsoas, iliotibial band, hamstring, rectus femoris, and gastrocsoleus muscles. Lower extremity injuries incurred during practice and play were recorded during the following year. RESULTS: Of the 201 athletes tested, 71 sustained 115 injuries. For each additional point on the 9-point ligamentous laxity scale (9 = hyperlax), the risk of injury decreased 16%. For each additional point on the 10-point muscle-tightness scale (10 = all muscles tight), the risk of injury increased 23%. The two scores were moderately inversely correlated (Spearman's rho = -0.3; p < .001). Women had greater mean (+/- SD) laxity scores than men (3.3 +/- 2.2 vs. 1.8 +/- 2.0; p < .001) and lower mean overall muscle tightness scores (1.5 +/- 1.6 vs. 3.5 +/- 2.1; p < .001). Among Women athletes, the rate of lower extremity injury was unrelated to ligamentous laxity or to flexibility. Among men, lower extremity injuries were associated with lower ligamentous laxity scores (p = .008) and greater muscle tightness (p = .04). CONCLUSIONS: This study introduces a new scale for lower extremity muscle tightness. Tight ligaments and muscles are related to injury in men, but not women, college athletes. A preseason flexibility program may decrease injuries in college men athletes.

Adult↗
PubMed2006

A large animal fatal extremity hemorrhage model and evaluation of a polymeric dressing (fatal extremity hemorrhage).

BACKGROUND: Extremity hemorrhage is a contributor to preventable battlefield mortality. The Army has liberalized tourniquet use guidelines in an attempt to prevent these deaths. To evaluate wound hemostatic agents that might allow for early tourniquet removal while maintaining hemorrhage control, a model of lethal extremity hemorrhage in the goat (Capra hircus) was developed and a polymeric dressing agent (BioFoam) tested. METHODS: After administration of a spinal block, animals were placed in lateral recumbancy with a head-up tilt of 6 degrees, 500 mL crystalloid was injected and 600 u/Kg of heparin was administered. After tourniquet application to the thigh, a soft tissue and vascular injury was created by transecting muscles and the femoral artery. The polymeric wound dressing was applied and the tourniquet was released. RESULTS: In testing, the primary endpoint was mortality within the first hour after tourniquet release. None of the control animals survived the full hour. Two out of five (40%) of the treated animals survived. With survivors' survival time calculated as 60 minutes, survival time was found not to differ between treated (34 +/- 19 minutes) and untreated (29 +/- 18 minutes) animals (p = 0.77). CONCLUSION: The physical characteristics of tissue injury, need for anticoagulation, and manipulation of blood pressure are vital factors contributing to the lethality of a large animal fatal extremity hemorrhage model. BioFoam was successful in preventing fatal arterial extremity hemorrhage after the release of an effective tourniquet in some cases. An agent that can reliably allow for safe tourniquet removal and restoration of collateral circulation is a potential solution to tourniquet-associated morbidity in traumatic extremity injury. The model developed will serve as a rigorous test for such agents.

Animals↗
PubMed1997

Electromyographic analysis of the squat performed in self-selected lower extremity neutral rotation and 30 degrees of lower extremity turn-out from the self-selected neutral position.

Little research is available on the muscle activity patterns of the lower extremity muscles during dynamic closed chain squatting activities. The purpose of this study was to examine the effect of lower extremity position during an Olympic squat on the muscle activity patterns of the vastus medialis, vastus lateralis, semimembranosus/semitendinosus, and biceps femoris. Twenty-five healthy, untrained subjects, 18-35 years old, were randomly assigned initial squatting positions of either self-selected neutral or 30 degrees of lower extremity turn-out from the self-selected neutral position. Surface electromyography and motion analysis data were collected simultaneously in 10 degrees intervals and analyzed from 10-60 degrees of knee flexion in both the ascending and descending phases of the squat. A four-way analysis of variance indicated that the main effect of lower extremity position and the interaction of extremity position and knee joint angles were not found to cause significant changes in muscle activity patterns. Significant changes in muscle activity did occur with changes in knee flexion angles in the vastus medialis and vastus lateralis but not in the semimembranosus/semitendinosus or biceps femoris.

Adolescent↗
PubMed1997

Genome screening using extremely discordant and extremely concordant sib pairs.

We applied extreme sib-pair methods in two ways to the GAW10 Problem 2A data sets to detect susceptible quantitative trait loci using extremely discordant sib pairs only, and combining them with the available extremely concordant sib pairs as suggested by the authors elsewhere. Ten successive original replicates were combined into one sampling pool so as to get the necessary number of extreme sib pairs. A total of 100 replicates were used to produce 10 such data sets for both initial detection and confirmations. Strong signals were found with markers D5G15 for Q1, D8G27-28 for Q4, and D9G7-9 for Q5.

Chromosome Mapping↗
PubMed2003

The impact of pelvic and lower extremity fractures on the incidence of lower extremity deep vein thrombosis in high-risk trauma patients. Winner of the Best Paper Award from the Gold Medal Forum.

Lower extremity fractures (LEFx) and pelvic fractures (PFx) are believed to increase the risk of lower extremity deep vein thrombosis (LEDVT). We studied trauma patients at high risk for LEDVT to determine whether an increased incidence of LEDVT was associated with LEFx and/or PFx. From January 1995 through December 1997 4163 trauma patients were admitted to our Level I trauma center. One thousand ninety-three patients at high risk for LEDVT were screened with serial lower extremity venous duplex ultrasound. Their medical records were retrospectively reviewed for demographics, mechanism of injury, and fracture data. The occurrence of LEDVT, pulmonary embolus, and LEDVT prophylaxis and treatment were noted. The incidence of LEDVT in the fracture group (Fx) was compared with that in the nonfracture group (NFx) using chi-square analysis and logistic regression. Statistical significance was set at < or = 0.05. Complete data were available for 1059 of 1093 patients. Five hundred sixty-nine (53.73%) patients had PFx and/or LEFx, 151 (14.26%) patients had PFx only, 317 (29.3%) patients had LEFx only, and 101 (9.54%) patients had both PFx and LEFx. Four hundred ninety (46.27%) patients had NFx. In 1059 patients LEDVT was detected in 125 (11.8%). Sixty-three patients in the Fx groups developed LEDVT (50.4%): 19 (15.2%) PFx patients, 15 (12.0%) PFx/LEFx patients, and 29 (23.2%) LEFx patients. Sixty-two (49.6%) NFx patients developed LEDVT. LEDVT incidence was not significantly different between the Fx and NFx groups or among the PFx, LEFx, and PFx/LEFx groups (P = 0.317). Nine patients developed pulmonary embolism: four NFx patients, two LEFx patients, two PFx patients, and one PFx/LEFx patient. Significant predictors of LEDVT were age and hospital length of stay. Mean age in patients with LEDVT was 47.58 years and in patients without LEDVT it was 40.89 years (P < 0.001). Mean hospital length of stay in patients with LEDVT was 29.81 days and in patients without LEDVT it was 16.84 days. The power of this study to detect differences representing medium effect sizes was greater than 90 per cent. We conclude that LEFx and/or PFx was not associated with an increased incidence of LEDVT in trauma patients at high risk for LEDVT. Lower extremity venous duplex ultrasound needs to be performed in both Fx and NFx groups to detect LEDVTs.

Adolescent↗
PubMed2006

Lower extremity nerve function in patients with lower extremity ischemia.

BACKGROUND: We determined whether lower extremity ischemia, as measured by the ankle brachial index (ABI), is associated with impaired lower extremity nerve function. METHODS: Participants included 478 persons with peripheral arterial disease (PAD) identified from noninvasive vascular laboratories and 292 persons without PAD identified from a general medicine practice and noninvasive vascular laboratories. Peripheral arterial disease was defined as an ABI lower than 0.90 (mild PAD: ABI, 0.70 to <0.90; moderate PAD: ABI, 0.50 to <0.70; and severe PAD: ABI, <0.50). The ABI and electrophysiologic measures of the peroneal, sural, and ulnar nerves were obtained. RESULTS: Among 546 participants without diabetes, PAD participants had significantly impaired peripheral nerve function in the upper and lower extremities compared with non-PAD participants. After adjusting for age, sex, race, smoking, height, body mass index, recruitment source, alcohol use, disk disease, spinal stenosis, cardiac disease, and cerebrovascular disease, these associations were not statistically significant. After adjusting for confounders among nondiabetic participants, those with severe PAD (ABI, <0.50) had poorer peroneal nerve conduction velocity (NCV) compared with participants without PAD (42.6 vs 44.8 m/s; P = .003) and poorer peroneal NCV compared with participants with mild PAD (42.6 vs 45.0 m/s; P = .001) or moderate PAD (42.6 vs 44.1 m/s; P = .03). Among 224 participants with diabetes, after adjusting for confounders, PAD was associated with poorer peroneal NCV (40.8 vs 43.5 m/s; P = .01), sural nerve amplitude (3.1 vs 4.8 muV; P = .045), and ulnar NCV (47.6 vs 50.2 m/s; P = .03) compared with those without PAD. CONCLUSIONS: Our findings suggest that leg ischemia impairs peroneal nerve function. This association is less strong in patients with diabetes, perhaps because of the overriding influence of diabetes on peripheral nerve function. Clinicians should consider screening for PAD in patients with idiopathic peroneal nerve dysfunction. Peripheral arterial disease-associated nerve dysfunction may contribute to PAD-associated functional impairment.

Aged↗
PubMed1987

Evolutionary relationships amongst archaebacteria. A comparative study of 23 S ribosomal RNAs of a sulphur-dependent extreme thermophile, an extreme halophile and a thermophilic methanogen.

The 23 S RNA genes representative of each of the main archaebacterial subkingdoms, Desulfurococcus mobilis an extreme thermophile, Halococcus morrhuae an extreme halophile and Methanobacterium thermoautotrophicum a thermophilic methanogen, were cloned and sequenced. The inferred RNA sequences were aligned with all the available 23 S-like RNAs of other archaebacteria, eubacteria/chloroplasts and the cytoplasm of eukaryotes. Universal secondary structural models containing six major structural domains were refined, and extended, using the sequence comparison approach. Much of the present structure was confirmed but six new helices were added, including one that also exists in the eukaryotic 5.8 S RNA, and extensions were made to several existing helices. The data throw doubt on whether the 5' and 3' ends of the 23 S RNA interact, since no stable helix can form in either the extreme thermophile or the methanogen RNA. A few secondary structural features, specific to the archaebacterial RNAs were identified; two of these were supported by a comparison of the archaebacterial RNA sequences, and experimentally, using chemical and ribonuclease probes. Seven tertiary structural interactions, common to all 23 S-like RNAs, were predicted within unpaired regions of the secondary structural model on the basis of co-variation of nucleotide pairs; two lie in the region of the 23 S RNA corresponding to 5.8 S RNA but they are not conserved in the latter. The flanking sequences of each of the RNAs could base-pair to form long RNA processing stems. They were not conserved in sequence but each exhibited a secondary structural feature that is common to all the archaebacterial stems for both 16 S and 23 S RNAs and constitutes a processing site. Kingdom-specific nucleotides have been identified that are associated with antibiotic binding sites at functional centres in 23 S-like RNAs: in the peptidyl transferase centre (erythromycin-domain V) the archaebacterial RNAs classify with the eukaryotic RNAs; at the elongation factor-dependent GTPase centre (thiostrepton-domain II) they fall with the eubacteria, and at the putative amino acyl tRNA site (alpha-sarcin-domain VI) they resemble eukaryotes. Two of the proposed tertiary interactions offer a structural explanation for how functional coupling of domains II and V occurs at the peptidyl transferase centre. Phylogenetic trees were constructed for the archaebacterial kingdom, and for the other two kingdoms, on the basis of the aligned 23 S-like RNA sequences.(ABSTRACT TRUNCATED AT 400 WORDS)

Archaea↗