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Left Arm (leave + arm)
Selected AbstractsTEACHING DEEP CANNULATION OF THE BILE DUCT DURING ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHYDIGESTIVE ENDOSCOPY, Issue 4 2007Kiichi Tamada When performing endoscopic retrograde cholangiopancreatography (ERCP), the smooth introduction of the duodenoscope into the papilla of Vater, an appropriate view of the papilla of Vater, and deep cannulation of the bile duct are essential. The operator must know the difference between the side-viewing endoscope and the forward-viewing endoscope. The rotation of the body and the left arm of the operator, switching with the left wrist, and dialing of the endoscope are essential for appropriately viewing the papilla of Vater. When training operators to do ERCP, a model is useful for helping them understand basic handling. The approach to deep cannulation of the bile duct should be selected based on the type of papilla (slit type, onion type, tongue protrusion type, flat type, and tumor type). Cannulation is more difficult in patients with the tongue protrusion-type of papilla than with a slit type, onion type, or tumor type. According to previous reports, therapeutic ERCP requires the ability to cannulate the common bile duct deeply 80% of the time; 180 to 200 supervised ERCP are necessary to achieve this success rate. [source] Functional characterization of a neuropeptide F-like receptor from Drosophila melanogasterEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 2 2003Guoping Feng Abstract A cDNA clone encoding a seven-transmembrane domain, G-protein-coupled receptor (NPFR76F, also called GPCR60), has been isolated from Drosophila melanogaster. Deletion mapping showed that the gene encoding this receptor is located on the left arm of the third chromosome at position 76F. Northern blotting and whole mount in situ hybridization have shown that this receptor is expressed in a limited number of neurons in the central and peripheral nervous systems of embryos and adults. Analysis of the deduced amino acid sequence suggests that this receptor is related to vertebrate neuropeptide Y receptors. This Drosophila receptor shows 62,66% similarity and 32,34% identity to type 2 neuropeptide Y receptors cloned from a variety of vertebrate sources. Coexpression in Xenopus oocytes of NPFR76F with the promiscuous G-protein G,16 showed that this receptor is activated by the vertebrate neuropeptide Y family to produce inward currents due to the activation of an endogenous oocyte calcium-dependent chloride current. Maximum receptor activation was achieved with short, putative Drosophila neuropeptide F peptides (Drm-sNPF-1, 2 and 2s). Neuropeptide F-like peptides in Drosophila have been implicated in a signalling system that modulates food response and social behaviour. The identification of this neuropeptide F-like receptor and its endogenous ligand by reverse pharmacology will facilitate genetic and behavioural studies of neuropeptide functions in Drosophila. [source] Effect of tourniquet pressure and intra-individual variability on plasma fibrinogen, platelet P-selectin and monocyte tissue factorINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2000J. L. Ritchie Small differences in levels of certain haemostatic components may be clinically significant. It is important therefore to eliminate potential sources of confounding variability. This study investigated the effect of removing tourniquet pressure prior to sample collection on plasma fibrinogen levels, platelet P-selectin and monocyte tissue factor expression. Blood was collected from the right arm under maintained tourniquet pressure and from the left arm following the release of pressure once the vein was sufficiently inflated for insertion of a needle. Whole blood was labelled within one hour of venepuncture to allow analysis of platelet P-selectin and monocyte tissue factor by flow cytometry. Plasma fibrinogen levels were analysed in samples stored at ,70 °C, for all individuals at the end of the study using a method based on the Clauss technique. Intra-individual variability for each of the components was assessed by collecting samples under tourniquet pressure from four individuals on the same day on three consecutive weeks. Intra-individual variations were greater than assay CVs for all three components. There were no significant differences between the two tourniquet methods of collection for fibrinogen, P-selectin or tissue factor. In conclusion, there is no reason not to use a tourniquet during collection of blood for analysis of plasma fibrinogen, platelet P-selectin or monocyte tissue factor. [source] First palaeopathological example of Kienböck's disease from early modern Sakhalin AinuINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2002M. Nakai Abstract A disorder of the carpal lunate has been diagnosed as Kienböck's disease in a skeleton of a middle-aged Ainu male that was excavated from Sakhalin Island, northeast Asia. The bone lesion is primarily and unilaterally associated with the right wrist, where the right carpal lunate is collapsed and the radiocarpal joint shows degenerative arthritis. Interestingly, the left arm is more robust than the right and the left elbow shows considerable osteoarthritis. The most plausible explanation for these pathologies is that after developing Kienböck's disease in the right wrist, excessive use of the left arm made his left arm robust and finally gave rise to osteoarthritis in the left elbow. In archaeology, where only a few osteochondroses have been reported up until now, the present example is the first diagnosis of Kienböck's disease in skeletal remains. Copyright © 2002 John Wiley & Sons, Ltd. [source] KSHV/HHV8-associated primary cutaneous plasmablastic lymphoma in a patient with Castleman's disease and Kaposi's sarcomaJOURNAL OF CUTANEOUS PATHOLOGY, Issue 2006Wenhua Liu Three months following the diagnosis of KS affecting a left cervical lymph node and Castleman's disease with bone marrow involvement, he presented with a subcutaneous, tender lesion on his left arm. A skin biopsy demonstrated a superficial and deep, interstitial-nodular infiltrate of severely atypical lymphoid cells showing plasmacytoid features, numerous mitotic figures, and frequent individual apoptotic tumor cells. The morphologic features were those of plasmablastic lymphoma (PBL). Immunohistochemical study showed that the lymphoma cells strongly expressed CD45, CD30, and KSHV/HHV8 latency-associated nuclear antigen. KSHV/HHV8 was also detected in the biopsy sections of the patient's KS and Castleman's disease. Epstein,Barr virus in situ hybridization was diffusely positive. In situ hybridization demonstrated ,-light chain restriction. Although KSHV/HHV8 has been individually associated with KS, Castleman's disease, and PBL, this appears to be the first reported case in which all three entities were present simultaneously in one person, suggesting a critical role of KSHV/HHV8 as a common denominator in the pathogenesis of these diseases. [source] Moyamoya-disease-related ischemic stroke in the postpartum periodJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Kei Miyakoshi Abstract Stroke during pregnancy or the puerperium is an extremely rare yet serious cause of perinatal morbidity and mortality. Moyamoya disease, a cerebrovascular occlusive pathology with a female predominance, may become symptomatic for the first time in association with pregnancy. A 36-year-old woman with postpartum pre-eclampsia suddenly developed hemiparesis in the left arm with dysarthria after the initiation of antihypertensive measures. Cranial magnetic resonance imaging and angiography revealed acute ischemic lesions in the right hemisphere along with the steno-occlusive lesions of bilateral terminal portions of the internal carotid artery, indicating Moyamoya disease. With anti-platelet medication, the patient recovered gradually and was diagnosed as having Moyamoya disease using conventional angiography 3 months postpartum. In this case, the fluctuations in blood pressure in association with pre-eclampsia appear to have exacerbated the clinical symptoms of Moyamoya disease. As such, Moyamoya disease should be considered as an underlying disease of ischemic stroke associated with pregnancy. [source] Genetic analysis of the strong gyrase site (SGS) of bacteriophage Mu: localization of determinants required for promoting Mu replicationMOLECULAR MICROBIOLOGY, Issue 4 2000M. L. Pato The Mu strong gyrase site (SGS), located in the centre of the Mu genome, is required for efficient Mu replication, as it promotes synapsis of the prophage termini. Other gyrase sites tested, even very strong ones, were unable to substitute for the SGS in Mu replication. To determine the features required for its unique properties, a deletion analysis was performed on the SGS. For this analysis, we defined the 20 bp centred on the midpoint of the 4 bp staggered cleavage made by gyrase to be the ,core' and the flanking sequences to be the ,arms'. The deletion analysis showed that (i) ,,40 bp of the right arm is required, in addition to core sequences, for both efficient Mu replication and gyrase cleavage; and (ii) the left arm was not required for efficient Mu replication, although it was required for efficient gyrase cleavage. These observations implicated the right arm as the unique feature of the SGS. The second observation showed that strong gyrase cleavage and Mu replication could be dissociated and suggested that even weak gyrase sites, if supplied with the right arm of the SGS, could promote Mu replication. Hybrid sites were constructed with gyrase sites that could not support efficient Mu replication. The SGS right arm was used to replace one arm of the strong pSC101 gyrase site or the weaker pBR322 site. The pSC101 hybrid site allowed efficient Mu replication, whereas the pBR322 hybrid site allowed substantial, but reduced, replication. Hence, it appears that optimal Mu replication requires a central strong gyrase site with the properties imparted by the right arm sequences. Possible roles for the SGS right arm in Mu replication are addressed. [source] DICHOTOMY OF CORTICAL PAIN PROCESSINGPAIN MEDICINE, Issue 2 2002Article first published online: 4 JUL 200 Jahangir Maleki, Rollin M. Gallagher, Pain Medicine and Rehabilitation Center, MCP/Hahnemann School of Medicine Introduction: Functional MRI and PET studies of cortical pain processing indicate segregated pain pathways above the thalamus. Although experimental pain may result in multiple areas of altered cortical activity, it is postulated that thalamic pain fibers known as the lateral system, projecting to sensory cortex, serve to localize pain, whereas medial pathways projecting to limbic cortex, process affective aspects of pain. Case Study: A 27 y/o female, with left upper extremity pain and severe allodynia from Complex Regional Pain Syndrome, Type I (CRPS I / RSD), after receiving intra-pleural bupivacaine blocks developed an ipsilateral focal-onset secondary generalized tonic clonic seizure. This was followed by one hour of post-ictal confusion. Simultaneously she developed a dense left-sided motor and sensory deficit (Todd's palsy) with a motor deficit resolving in one day whereas a sensory deficit lasted 2 days. Throughout the duration of the sensory deficit she denied any left arm pain, although she continued to report the same intensity of pain, but now localized to her epigastric region. Interestingly, despite the lack of sensory perception on the left side, palpation of her left arm resulted in increased epigastric pain and suffering. Discussion: This case indicates a bifurcation of the pain pathway between the thalamus and cortex. Due to focal seizure activity, the sensory cortex (i.e. lateral system) was transiently rendered dysfunctional, during which time the continued presence of pain and allodynia without appropriate localization likely resulted from pain conduction, from the thalamus to functional limbic structures such as Cingulum (i.e. via the medial fibre system). Conclusion: This case report strongly supports the hypothesis of medial and lateral pain conducting fibers branching at the level of thalamus with medial sub-serving the emotional aspects of pain by projection to limbic cortex, whereas lateral fibres project to sensory cortex, primarily serving a localizing function. [source] Transdermal Fentanyl: Little Absorption in Two Patients with Systemic Sclerosis?PAIN MEDICINE, Issue 3 2001Matthias Karst MD Two patients suffering from systemic sclerosis (SSc) were treated with the 25 ,/hr transdermal fentanyl patch for pain from either deltoid muscle tendinitis of the left arm or from ischemia of the left-hand thumb. When the medication was changed to either oral morphine or oral methadone, the effects did not correspond to the drug conversion table. These findings suggest that patients with SSc and other systemic skin diseases may be at risk for limited absorption of transdermal fentanyl. In contrast, no restriction of the absorption of transdermal testosterone was observed. [source] Hereditary neuropathy with liability to pressure palsies and anaesthesia: peri-operative nerve injuryANAESTHESIA, Issue 10 2006L. Wijayasiri Summary A 43-year-old female with carcinoma of the left breast underwent wide local excision of the tumour and sentinel lymph node biopsy under general anaesthesia. Three lymph nodes were removed uneventfully during the operation. Postoperatively, the patient complained of weakness and decreased sensation of her left arm. A diagnosis of peri-operative neuropraxia was made. This resolved completely over the following 4 weeks. Genetic testing confirmed a diagnosis of hereditary neuropathy with liability to pressure palsies. [source] Trichilemmal cyst with homogeneous blue pigmentation on dermoscopyAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2009Gulsum Gencoglan ABSTRACT A 61-year-old woman was referred to our dermoscopy unit for a pigmented lesion that had been present on her left arm for 8 years. The patient did not notice any enlargement or change in colour. On dermoscopy, homogeneous blue pigmentation was seen. The lesion was excised with the pre-operative diagnosis of melanoma, blue naevus and dermatofibroma. Histopathological examination showed a trichilemmal cyst in the mid-dermis. Although homogeneous blue pigmentation on dermoscopy is the hallmark of blue naevus, it may be seen in metastatic melanoma and exceptionally in hemosiderotic and cellular types of dermatofibroma. Trichilemmal cyst should be borne in mind also in the dermoscopic differential diagnosis. [source] Necrobiotic xanthogranuloma occurring within linear morphoeaAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2002Suresh Chandra SUMMARY A 32-year-old woman with linear morphoea of her left arm was noted to have a yellowish atrophic plaque within the linear morphoea. Review of photographs taken on her first visit 3 years previously revealed that the lesion had been present and had increased in size over the 3 years. Necrobiotic xanthogranuloma (NXG) was diagnosed on biopsy. Paraproteinaemia was not detected. The NXG was surgically excised and it has not recurred in 12 months of follow up. [source] In situ photoimmunotherapy: a tumour-directed treatment for melanomaBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2006M.F. Naylor Summary We report a new immunological treatment for advanced cutaneous melanoma which combines laser stimulation with topical application of a toll-like receptor agonist. This treatment, in situ photoimmunotherapy (ISPI), provides an alternative to traditional therapies for melanoma patients with cutaneous metastases. A 6-week cycle of ISPI is carried out on cutaneous metastases located in a designated 20 × 20 cm treatment area: 2 weeks of pretreatment with twice-daily topical applications of imiquimod (5% cream under plastic occlusion), with a laser treatment session at week 2 and again at week 4. Topical imiquimod is continued for the entire 6-week cycle. Two patients with late-stage melanoma were treated with ISPI. Patient 1 had the primary tumour and local metastases on the left arm, as well as metastatic tumours in the lungs [American Joint Committee on Cancer (AJCC) stage IV]. Patient 2 had a head and neck melanoma with multiple local metastases (AJCC stage IIIC), which had failed repeated attempts at surgical resection and high-dose radiation therapy. Patient 1 is now free of all clinically detectable tumours (including the lung metastases) >20 months after the first treatment cycle. Patient 2 has been free of any clinical evidence of the tumour for over 6 months. These two cases demonstrate that ISPI can clear local tumour and trigger beneficial systemic responses, with a side-effect profile that compares favourably with other treatments for advanced melanoma. [source] Extensive skin necrosis of the arm in a patient with complex regional pain syndromeCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 6 2008M. Nishikawa Summary We report a 36-year-old woman with complex regional pain syndrome (CRPS) type 1 presenting with extensive skin necrosis of the left arm. The patient cooled her arm with ice packs to ease severe pain due to CRPS, in spite of repeated cautions against frostbite injury. The regions of skin necrosis corresponded with the sites where she had applied ice packs. We considered that the severe skin necrosis in our case was due to a self-induced frostbite injury. [source] Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial arteryCLINICAL ANATOMY, Issue 8 2004Bappaditya Ray Abstract Anatomical variations of the coracobrachialis muscle (CBM) are common. We detected an abnormal form of the CBM of the left arm during human cadaver dissection. The CBM originated from the tip of the coracoid process of the scapula and divided into muscular and musculo-aponeurotic bellies. The muscular belly inserted into the middle of the anteromedial surface of the humerus, which is the normal anatomic insertion point of the CBM. The musculo-aponeurotic belly inserted into the medial intermuscular septum as well as the brachial fascia, creating a tunnel for the passage of the brachial artery. Inside the tunnel, the brachial artery bifurcated into the radial and ulnar arteries. No abnormality of the CBM, the brachial artery, or the median nerve was detected in the contralateral arm. The phylogenic, ontogenic, functional, and clinical importance of this variant muscle is described. Knowledge of such variations is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures. Clin. Anat. 17:672,676, 2004. © 2004 Wiley-Liss, Inc. [source] Two bellies of the coracobrachialis muscle associated with a third head of the biceps brachii muscleCLINICAL ANATOMY, Issue 5 2001Mostafa M. El-Naggar Abstract Reports that describe the abnormalities and complexities of the anatomy of the arm are important with regard to surgical approaches. This case study reports a combined abnormal form of the coracobrachialis and biceps brachii muscles of the left arm of an adult male cadaver that was detected during the educational gross anatomy dissections of embalmed cadavers. The coracobrachialis muscle demonstrated two bellies which formed shortly inferior to its origin from the coracoid process of the scapula. One belly inserted into the middle of the antero-medial surface of the humerus, whereas the other belly inserted into the medial head of the triceps brachii muscle. The musculocutaneous nerve passed between the two bellies, giving a separate branch to each. We suggest that the two bellies of the coracobrachialis muscle may represent the incompletely fused short heads of the ancestral muscle. The biceps brachii muscle showed a third head, which originated mainly from the antero-medial surface of the humerus and partially from an aponeurosis belonging to the medial head of the triceps brachii muscle. These observations were confined to the left upper limb and were not accompanied by any other abnormality. Clin. Anat. 5:379,382, 2001. © 2001 Wiley-Liss, Inc. [source] Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of LiteratureCLINICAL CARDIOLOGY, Issue 10 2008Fehmi Kacmaz MD Abstract A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period. Copyright © 2008 Wiley Periodicals, Inc. [source] | |||||||||||||