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Extremities
Kinds of Extremities Terms modified by Extremities Selected AbstractsAn Examination of Clothing Issues and Physical Limitations in the Product Development ProcessFAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 1 2010Katherine Carroll The purpose of this study was to explore physical limitations and clothing problems among working women with physical disabilities to determine whether types of physical limitations are linked to specific clothing problems. The sample included 117 working women with a variety of disabilities. Principle Components Factor Analysis and Multiple Regression were used to analyze the data. Three distinct factors emerged to represent clothing problems (called Design, Materials Performance, and Dressing) and four distinct factors emerged to represent physical limitations (called Limbs/Outer Extremities, Central Core/Torso, Central Nervous System, and Intellect, Vision and Hearing). Regression analysis showed that the physical limitations impact each of the three clothing factors. The study extends research by focusing on an underserved market segment and providing the apparel industry with a potential method of addressing the needs of that market. The study also contributes to interdisciplinary research by further developing an Inclusive Design model for apparel product development. [source] Isolation of Sporothrix schenckii from the environmental sources of cutaneous sporotrichosis patients in Himachal Pradesh, India: results of a pilot studyMYCOSES, Issue 6 2007Karan Inder Singh Mehta Summary Himachal Pradesh, India is a known endemic area for cutaneous sporotrichosis. No attempt has been made to isolate Sporothrix schenckii, the causative fungus, from environmental sources in this region or in India as such. This prospective study was carried out to isolate Sporothrix schenckii from different environmental samples collected from the vicinity of cutaneous sporotrichosis patients. All patients of cutaneous sporotrichosis diagnosed during March 2005,February 2006 were studied. Twenty-one biopsy specimens and 62 environmental samples of soil, various thorns, corn-stalk, grass-blades and sphagnum moss were subjected to mycologic culture on Sabouraud's glucose agar. Sporothrix schenckii was identified by colony characteristics, lacto-phenol cotton blue mounts and demonstration of temperature dimorphism. These patients (F : M 15 : 6) were between 12 and 72 years of age and had cutaneous lesions for 45 days to 4 years. Lymphocutaneous and fixed cutaneous sporotrichosis was seen in 14 (66.6%) and 7 (33.3%) patients respectively. Extremities were involved in 16 (76.2%); and 5 (23.8%) patients had facial lesions. Ten (47.4%) biopsy specimens and six environmental (three soil, three corn-stalk) samples were culture-positive, which showed morphological characteristics suggesting Sporothrix schenckii. No variation in colony characteristics and mycelial morphology was observed in growth isolates from clinical or environmental samples. Temperature dimorphism was observed in all the 10 isolates obtained from the clinical specimens and in two isolates cultured from corn-stalk. Corn-stalks are evidently important sources of Sporothrix schenckii infection although subsequent contamination of wounds appears more important for development of clinical disease. Culture of Sporothrix schenckii from environmental sources may not be always possible to correlate with profile of injuries. [source] Spinal Cord Stimulation in Critical Limb Ischemia of the Lower ExtremitiesNEUROMODULATION, Issue 3 2003Vincenzo Sciacca MD. [source] Neurorehabilitation of Upper Extremities in Humans with Sensory-Motor ImpairmentNEUROMODULATION, Issue 1 2002Dejan B. Popovic PhD Abstract Today most clinical investigators agree that the common denominator for successful therapy in subjects after central nervous system (CNS) lesions is to induce concentrated, repetitive practice of the more affected limb as soon as possible after the onset of impairment. This paper reviews representative methods of neurorehabilitation such as constraining the less affected arm and using a robot to facilitate movement of the affected arm, and focuses on functional electrotherapy promoting the movement recovery. The functional electrical therapy (FET) encompasses three elements: 1) control of movements that are compromised because of the impairment, 2) enhanced exercise of paralyzed extremities, and 3) augmented activity of afferent neural pathway. Liberson et al. (1) first reported an important result of the FET; they applied a peroneal stimulator to enhance functionally essential ankle dorsiflexion during the swing phase of walking. Merletti et al. (2) described a similar electrotherapeutic effect for upper extremities; they applied a two-channel electronic stimulator and surface electrodes to augment elbow extension and finger extension during different reach and grasp activities. Both electrotherapies resulted in immediate and carry-over effects caused by systematic application of FET. In studies with subjects after a spinal cord lesion at the cervical level (chronic tetraplegia) (3,5) or stroke (6), it was shown that FET improves grasping and reaching by using the following outcome measures: the Upper Extremity Function Test (UEFT), coordination between elbow and shoulder movement, and the Functional Independence Measure (FIM). Externally applied electrical stimuli provided a strong central sensory input which could be responsible for the changes in the organization of impaired sensory-motor mechanisms. FET resulted in stronger muscles that were stimulated directly, as well as exercising other muscles. The ability to move paralyzed extremities also provided awareness (proprioception and visual feedback) of enhanced functional ability as being very beneficial for the recovery. FET contributed to the increased range of movement in the affected joints, increased speed of joint rotations, reduced spasticity, and improved functioning measured by the UEFT, the FIM and the Quadriplegia Index of Function (QIF). [source] Erosions and Scars over the Face, Trunk, and ExtremitiesPEDIATRIC DERMATOLOGY, Issue 1 2009Ruba Bahhady M.D. First page of article [source] Overcoming Abnormal Joint Torque Patterns in Paretic Upper Extremities Using Triceps StimulationARTIFICIAL ORGANS, Issue 3 2005Thierry Keller Abstract:, The goal of this research project was to quantitatively assess whether transcutaneous triceps stimulation can overcome the expression of abnormal torque patterns in the paretic upper limb of subjects with hemiparetic stroke. Abnormal torque patterns consist of strong coupling between shoulder abduction (SAB) and elbow flexion (EF) or between elbow extension (EE) and shoulder adduction (SAD) torques. Both patterns reduce the active range of motion during arm movements. Eight chronic stroke subjects with moderate to severe (Fugl-Meyer assessment scores of 21/66,36/66) upper limb motor impairment participated in this study. Shoulder and elbow joint torques were measured with a 6-degrees-of-freedom load cell under isometric conditions, while the triceps muscle was stimulated to generate EE torques. At the same time the subjects were asked to lift up their arm to generate different SAB torque levels. The obtained isometric results showed that electrical stimulation can overcome abnormal torque patterns in chronic stroke subjects while generating SAB. This is likely to have potential benefits to increase the, reaching, workspace, of, the, paretic, arm. [source] Lower-extremity selective voluntary motor control in patients with spastic cerebral palsy: increased distal motor impairmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2010EILEEN G FOWLER Aim, Multiple impairments contribute to motor deficits in spastic cerebral palsy (CP). Selective voluntary motor control (SVMC), namely isolation of joint movement upon request, is important, but frequently overlooked. This study evaluated the proximal to distal distribution of SVMC impairment among lower extremity joints. Method, Using a recently developed tool, the Selective Control Assessment of the Lower Extremity (SCALE), we evaluated the SVMC of the hip, knee, ankle, subtalar joint, and toes in a cross-sectional, observational study of 47 participants with spastic, diplegic, hemiplegic, and quadriplegic CP (22 males, 25 females; mean age 11y 9mo, SD 4y 8mo; Gross Motor Function Classification System levels I,IV). Results, Statistically significant decreases in SCALE scores from hip to toes were found using the Page statistical test for trend (p<0.001). Statistically significant differences (p<0.05) were found between all joint pairs, except toes versus subtalar, toes versus ankle, and right ankle versus subtalar joints. Cross-tabulation of score frequencies for all pairs revealed that proximal joint scores were higher or equal to distal ones 81 to 100% of the time. Excluding toes versus subtalar joints, proximal scores exceeded distal ones 94 to 100% of the time. Interpretation, We confirmed increasing proximal to distal SVMC impairment, which may have implications for treatment and research. [source] Selective Control Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2009EILEEN G FOWLER PhD PT Normal selective voluntary motor control (SVMC) can be defined as the ability to perform isolated joint movement without using mass flexor/extensor patterns or undesired movement at other joints, such as mirroring. SVMC is an important determinant of function, yet a valid, reliable assessment tool is lacking. The Selective Control Assessment of the Lower Extremity (SCALE) is a clinical tool developed to quantify SVMC in patients with cerebral palsy (CP). This paper describes the development, utility, validation, and interrater reliability of SCALE. Content validity was based on review by 14 experienced clinicians. Mean agreement was 91.9% (range 71.4,100%) for statements about content, administration, and grading. SCALE scores were compared with Gross Motor Function Classification System Expanded and Revised (GMFCS-ER) levels for 51 participants with spastic diplegic, hemiplegic, and quadriplegic CP (GMFCS levels I , IV, 21 males, 30 females; mean age 11y 11mo [SD 4y 9mo]; range 5,23y). Construct validity was supported by significant inverse correlation (Spearman's r=-0.83, p<0.001) between SCALE scores and GMFCS levels. Six clinicians rated 20 participants with spastic CP (seven males, 13 females, mean age 12y 3mo [SD 5y 5mo], range 7,23y) using SCALE. A high level of interrater reliability was demonstrated by intraclass correlation coefficients ranging from 0.88 to 0.91 (p<0.001). [source] Changes of Extremity and Laryngeal Muscle Electromyographic Amplitudes After Intravenous Administration of Vecuronium,THE LARYNGOSCOPE, Issue 12 2008Yongbing Shi MD Abstract Objectives: To compare electromyographic (EMG) amplitude changes in extremity and laryngeal muscles after vecuronium administration and study the effects of topical lidocaine on laryngeal EMG in a swine model. Study Design: Prospective animal study. Methods: Electrically evoked EMG activities were recorded from the vocalis muscles (directly and via an EMG endotracheal tube) and from the flexor digitorum muscles before and after intravenous vecuronium administration. EMG amplitudes were followed for 30 minutes after vecuronium injection together with monitoring of limb twitches to train-of-four stimulation. The testing was repeated after a 30-minute wash-out period and with topical lidocaine. Results: EMG amplitude recovery occurred sooner and more quickly in flexor digitorum muscle than in vocalis muscles. Reappearance of four twitches corresponded to EMG amplitude recovery to about 80% of the baseline in flexor digitorum muscles and to about half-baseline size in vocalis muscles. EMG amplitudes were generally lower at the start of the second round testing than the first round, with somewhat slower recovery in vocalis muscles. Conclusions: In contrast to reports by others in human studies, extremity muscles seem to be more resistant to vecuronium at 0.1 mg/kg than laryngeal muscles in the swine. Reappearance of four twitches corresponds to 50% of laryngeal EMG recovery and indicates adequate condition for monitoring electrically evoked laryngeal EMG activities. This study is inconclusive regarding the effects of topically applied lidocaine on laryngeal EMG amplitudes. Translation of these data to humans should be done with caution. [source] European Standard Series patch test results from a contact dermatitis clinic in Israel during the 7-year period from 1998 to 2004CONTACT DERMATITIS, Issue 2 2006Aneta Lazarov The results of a 7-year retrospective study (1998,2004) from patch testing with the European Standard Series (ESS) establishing the frequency of sensitization in a contact dermatitis clinic in Israel are presented. 23 allergens were patch tested on 2156 patients, 1462 females (67.8%) and 694 males (32.2%). Atopy and asthma were present in 21.9% of the patients. One or more allergic reactions were observed in 937 patients (43.5%). The highest yield of patch test positives from the 1076 positive reactions were obtained from nickel sulfate (13.9%), fragrance mix (7.1%), potassium dichromate (3.8%), Balsam of Peru (3.6%), CL + Me-isothiazolinone (3.4%) and cobalt chloride (3.4%). Allergens which produced the least amount of positive results were primin and clioquinol. Allergic contact dermatitis (ACD) was established in 32.8%, whereas occupationally related allergic (8.0) and irritant contact dermatitis (5.6%) affected a total of 13.6% of the cases studied. The most common clinical forms of dermatitis were chronic dermatitis (47.7%) followed by acute dermatitis (22.8%), and lichenification and hyperkeratosis (7.9%). The hands (30.7%), face and neck (23.9%) and extremities (11.3%) were the most frequently affected areas. Four allergens in our study differed from the top 10 allergens in Europe namely: Cl + Me-isothiazolinone, formaldehyde, 4-tert-butylphenol formaldehyde resin and sesquiterpene lactone mix reflecting an existing difference in environmental exposure. Our study is the first to provide data on the frequency of sensitization and important allergens in the aetiology of ACD in Israel. In spite of the existing differences with Europe, we conclude that ESS is an appropriate screening system for the diagnosis of ACD in Israel. [source] FC03.2 Cumulative incidence of self reported skin disease in hydrotherapists working in swimming poolsCONTACT DERMATITIS, Issue 3 2004Aneta Lazarov Objective:, To assess the cumulative incidence and characteristics of self reported skin disease in hydrotherapists. Methods:, Hydrotherapists, who had completed a hydrotherapy training course answered a questionnaire in reference to newly appeared skin disease. Data were analyzed statistically. Results:, 190 subjects presently working as hydrotherapists were studied. Of them 75.8% were female and 24.2% were male. 80% of the hydrotherapists worked up to 10 000 cumulative hours defined by the formula: working hours per weeks × number of weeks per year × years of work in the pool. 85 of the subjects (45%) reported on the development of skin disease for the first time after starting work at the swimming pool. 21 (11.8%) had a preexisting skin disease. The most frequent symptoms included pruritus, burning, stinging, erythematous patches and xerotic skin on the extremities, trunk and folds. A statistically significant relationship between the cumulative working time and the incidence of dermatological pathology compatible with contact dermatitis was found. Conclusions:, The incidence of self reported skin diseases, developing for the first time or due to exacerbation of preexisting dermatological conditions, in hydrotherapists working in swimming pools is high. Statistically significant relationship between the cumulative hours of immersion in the pool and the incidence of the dermatological pathology was observed suggesting a dose response relationship between exposure and effect. [source] Non-pigmenting fixed drug eruption caused by allylisopropylacetylureaCONTACT DERMATITIS, Issue 4 2003Yukikazu Numata An unusual case of a non-pigmenting fixed drug eruption caused by allylisopropylacetylurea is reported. Several hours after taking an analgesic (New Kaiteki A®), a 30-year-old Japanese woman, who had experienced similar eruptions several times after taking other analgesics, developed numerous variously sized, itchy, round-to-oval erythematous eruptions on the trunk and extremities. After she discontinued taking this drug, all such eruptions resolved within 2 weeks, without leaving postinflammatory pigmentation. Patch testing with New Kaiteki A® itself and one of its active ingredients, allylisopropylacetylurea, on lesional skin, but not on uninvolved skin, showed positive erythematous reactions after 2 days. [source] Nonvisible Insufficient Subcutaneous Reticular Venous Plexus Can Be Observed through the Skin Using a New Illumination MethodDERMATOLOGIC SURGERY, Issue 2010LUIS LOPEZ BUSTOS MD BACKGROUND Insufficient subcutaneous reticular venous plexus (ISRVP) is an overlooked disease because the human eye cannot see many of the insufficient veins. OBJECTIVE To present a total reticular vision (TRV) method that exposes nonvisible ISRVP to normal vision. METHOD & MATERIALS TRV used visual-spectrum white and red light of 700 nm and infrared light of 15 to 850 nm from an ultradigital viewer camera. We studied 124 asymptomatic subjects from the general population without visible ISRVP. Another six patients with ISRVP without other venous pathology were compared with six healthy controls, Very low pressure was applied to the proximal thigh, and minimal volume increments on the medial malleolus were photoplethysmographically registered to validate subcutaneous venous reflux. RESULTS Total reticular vision exposed ISRVP on the lower extremities in 72 of 124 subjects (58%), with observed damaged veins corresponding to more than 90% of nonvisible and 5% of visible portions of ISRVP. Subcutaneous reflux was registered only in patients with ISRVP. CONCLUSION Total reticular vision exposed more than 90% of nonvisible ISRVP, a new pathology, allowing for the study of its relationship with other superficial venous insufficiencies. The authors have indicated no significant interest with commercial supporters. [source] Utility of Intralesional Sclerotherapy with 3% Sodium Tetradecyl Sulphate in Cutaneous Vascular MalformationsDERMATOLOGIC SURGERY, Issue 3 2010MNAMS, SUJAY KHANDPUR MBBS BACKGROUND Vascular malformations have devastating cosmetic effects in addition to being associated with pain and bleeding. Sclerotherapy has been successfully used in treating complicated hemangiomas and vascular malformations. OBJECTIVES To assess the efficacy of sclerotherapy with 3% sodium tetradecyl sulphate (STS) in venous and lymphatic malformations. MATERIALS AND METHOD We performed sclerotherapy with 3% STS in 13 patients with venous malformations and microcystic lymphatic malformation, all low-flow malformations and with extent predominantly to the subcutis, confirmed using Doppler ultrasound. Lesions were located on the face, lower lip, flanks, buttocks, and extremities. Patients presented for cosmetic reasons, pain, or bleeding. Sclerotherapy was undertaken as an office procedure without any radiological guidance and therapy repeated every 3 weeks. Therapeutic efficacy was assessed subjectively clinically and photographically. RESULTS The lesions regressed by 90% to 100% in 11 cases after a mean of four injections, with no improvement in two cases (one each of venous malformation and lymphatic malformation). Complications included cutaneous blister formation, erosions, and crusting at injection site in seven cases and atrophic scarring in four patients. CONCLUSIONS Sclerotherapy with 3% STS is a simple, safe, and effective modality for venous malformations and can be undertaken as an office procedure in lesions limited to the subcutis. The authors have indicated no significant interest with commercial supporters. [source] Frequency of Use of Suturing and Repair Techniques Preferred by Dermatologic SurgeonsDERMATOLOGIC SURGERY, Issue 5 2006BETH ADAMS MD BACKGROUND There are many closure techniques and suture types available to cutaneous surgeons. Evidence-based data are not available regarding the frequency of use of these techniques by experienced practitioners. OBJECTIVE To quantify, by anatomic site, the frequency of use of common closure techniques and suture types by cutaneous surgeons. METHOD A prospective survey of the members of the Association of Academic Dermatologic Surgeons that used length-calibrated visual-analog scales to elicit the frequency of use of specific suture techniques. RESULTS A response rate of 60% (61/101) indicated reliability of the received data. Epidermal layers were closed most often, in descending order, by simple interrupted sutures (38,50%), simple running sutures (37,42%), and vertical mattress sutures (3,8%), with subcuticular sutures used more often on the trunk and extremities (28%). The most commonly used superficial sutures were nylon (51%) and polypropylene (44%), and the most common absorbable suture was polyglactin 910 (73%). Bilayered closures, undermining, and electrocoagulation were used, on average, in 90% or more sutured repairs. The median diameters (defined as longest extent along any axis) of most final wound defects were 1.1 to 2.0 cm (56%) or 2.1 to 3.0 cm (37%). Fifty-four percent of wounds were repaired by primary closure, 20% with local flaps, and 10% with skin grafting, with the remaining 15% left to heal by second intent (10%) or referred for repair (5%). Experience-related differences were detected in defect size and closure technique: defects less than 2 cm in diameter were seen by less experienced surgeons, and defects greater than 2 cm by more experienced surgeons (Wilcoxon's rank-sum test: p=.02). But more experienced surgeons were less likely to use bilayered closures (r=,0.28, p=.036) and undermining (r=,0.28, p=.035). CONCLUSIONS There is widespread consensus among cutaneous surgeons regarding optimal suture selection and closure technique by anatomic location. More experienced surgeons tend to repair larger defects but, possibly because of their increased confidence and skill, rely on less complicated repairs. [source] Advancement Flaps: A Basic Theme with Many VariationsDERMATOLOGIC SURGERY, Issue 2005Ravi Krishnan MD Background. The advancement flap involves the linear advancement of tissue in one direction. Despite its straightforwardness and simple concept, it can be used to close a variety of defects, ranging from small defects on the scalp or extremities to large, complicated defects involving cosmetic units on the face. Objectives. To provide a basic and useful review for the indications, advantages, disadvantages, and techniques for the use of advancement flaps in the reconstruction of defects in dermatologic surgery. Materials and Methods. We performed a literature search for articles discussing advancement flaps and compiled a brief review of our findings. Results. The movement of the advancement flap must be balanced by the blood supply of the flap. The excision of Burow's triangles along various aspects of the advancement flap can increase movement and improve cosmesis of the flap. The types of advancement flaps discussed include the single advancement flap, double advancement flap, A-T flap (O-T flap), Burow's triangle flap (Burow's wedge flap), crescenteric advancement flap, island pedicle flap (V-Y flap), helical rim advancement flap, and facelift flap. Conclusion. Advancement flaps are versatile and useful basic flaps for repairing defects. [source] Idiopathic Circumscripta Calcinosis Cutis of the KneeDERMATOLOGIC SURGERY, Issue 12 2003FACS, Luigi Valdatta MD Background. Calcinosis cutis, a disease characterized by the presence of calcium deposits in the skin, is classified into four types according to etiology: dystrophic, metastatic, iatrogenic and idiopathic. The dystrophic form is the most common while the idiopathic one is the rarest, but specific incidence and frequency data are not available in scientific literature. Objective. Calcinosis cutis circumscripta is a very rare form of idiopathic calcinosis cutis arising in the second half of life. It typically involves the extremities and is associated with prior trauma and scleroderma. We dealt with a very rare form of calcinosis cutis circumscripta in a healthy patient, for whom surgical excision revealed to be an effective and successful treatment. Methods and materials. We present the case of a 46-year-old woman affected by idiopathic circumscripta calcinosis cutis of the left knee, successfully treated by surgical removal. Discussion. Medical and surgical treatment are options to cure calcinosis cutis. Medical therapy is not very effective. Surgical excision has shown to be beneficial, as it can provide a symptomatic relief. However, since calcinosis cutis limits are not always well defined a recurrence of the lesions may occur. [source] CO2 Laser Treatment of Epidermal Nevi: Long-Term SuccessDERMATOLOGIC SURGERY, Issue 7 2002Sarah Boyce MD background. Epidermal nevi have been notoriously difficult to treat due to their large size and often conspicuous location. Variable results have been obtained with different laser treatments, and scarring and/or incomplete removal is typical after excisional or other destructive modalities. objective. To outline the successful use of a short-pulsed CO2 laser in the long-term eradication of epidermal nevi in three patients. methods. Three females (ages 15,19) presented with extensive grouped verrucous papules and plaques on the face, trunk, and extremities. A pulsed CO2 laser was used to vaporize the lesions using a 500 mJ pulse energy, 3 mm spotsize, and 7 watts of power. results. All lesions healed without incident. No lesional recurrence was observed 10 to 13 months after treatment except in one small area on the ankle in one patient. conclusions. Carbon dioxide laser vaporization of epidermal nevi provides good clinical effect and offers unique advantages for the treatment of these lesions, including effective intraoperative hemostasis with excellent lesional visualization. It is also possible to treat widespread areas in one laser treatment session. While the results of this series clearly show the benefit of CO2 laser treatment, epidermal nevi may not always respond so favorably, due in part to the variability in their depths of involvement. [source] Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite LaserDERMATOLOGIC SURGERY, Issue 11 2001Sorin Eremia MD Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source] A Painless Subungual Osteoid OsteomaDERMATOLOGIC SURGERY, Issue 8 2001Pelin Ekmekci MD Background. Osteoid osteoma is a benign bone tumor. Its etiology is not fully understood and the role of trauma is still elusive. Objective. Osteoid osteoma mostly presents with a poorly localized pain that is worst at night and characteristically relieved by salicylates. It usually occurs on the weight-bearing bones of the lower extremities, but toe location is quite rare. Here, we present a case of painless osteoid osteoma located subungually on the dorsum of the great toe. Result. A 29-year-old woman presented with a painless subungual mass on the dorsum of her great toe. Subungual exotosis, osteochondroma, and osteoma were considered in the differential diagnosis and the lesion was totally excised. Histopathologic examination showed characteristic findings of osteoid osteoma. Conclusion. A painless osteoid osteoma is rarely seen and it can be easily misdiagnosed if it occurs in an atypical location such as the subungual area. [source] De Novo Malignant Eccrine Spiradenoma with an Interesting and Unusual LocationDERMATOLOGIC SURGERY, Issue 4 2001Serkan Yildirim MD Background. Reports in the literature reveal that malignant eccrine spiradenomas (MES) are exceedingly rare, and represent aggressive tumors arising in long-standing benign eccrine spiradenomas (ES). Objective. We present a de novo case of MES of the nose, in contrast to reports in the literature of progression from long-standing benign lesions. Methods. Case report and brief review of the literature. Results. Our case was accepted as de novo MES because there was no evidence of ES on pathologic examination. It was treated by surgical excision with 1 cm tumor-free margins. No recurrence or complications were observed for 2 months, but long-term follow-up could not be performed because the patient died of adenocarcinoma of the colon. Conclusion. Although previously reported lesions have arisen in long-standing benign ESs, usually on the trunk or extremities, this report shows that MES may occur as a primary malignant tumor and may occur in unusual locations such as the nose. [source] Orthopaedic issues in the musculoskeletal care of adults with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2009HELEN M HORSTMANN MD Aims, Orthopaedic care of adults with cerebral palsy (CP) has not been well documented in orthopaedic literature. This paper focuses on some of the common problems which present themselves when adults with CP seek orthopaedic intervention. In particular, we review the most common orthopaedic issues which present to the Penn Neuro-Orthopaedics Program. Method, A formal review of consecutive surgeries performed by the senior author on adults with CP was previously conducted. This paper focuses on the health delivery care for the adult with orthopaedic problems related to cerebral palsy. Ninety-two percent of these patients required lower extremity surgery. Forty percent had procedures performed on the upper extremities. Results, The majority of problems seen in the Penn Neuro-Orthopaedics Program are associated with the residuals of childhood issues, particularly deformities associated with contractures. Patients are also referred for treatment of acquired musculoskeletal problems such as degenerative arthritis of the hip or knee. A combination of problems contribute most frequently to foot deformities and pain with weight-bearing, shoewear or both, most often due to equinovarus. The surgical correction of this is most often facilitated through a split anterior tibial tendon transfer. Posterior tibial transfers are rarely indicated. Residual equinus deformities contribute to a pes planus deformity. The split anterior tibial tendon transfer is usually combined with gastrocnemius-soleus recession and plantar release. Transfer of the flexor digitorum longus to the os calcis is done to augment the plantar flexor power. Rigid pes planus deformity is treated with a triple arthrodesis. Resolution of deformity allows for a good base for standing, improved ability to tolerate shoewear, and/or braces. Other recurrent or unresolved issues involve hip and knee contractures. Issues of lever arm dysfunction create problems with mechanical inefficiency. Upper extremity intervention is principally to correct contractures. Internal rotation and adductor tightness at the shoulder makes for difficult underarm hygiene and predispose a patient to a spiral fracture of the humerus. A tight flexor, pronation pattern is frequently noted through the elbow and forearm with further flexion contractures through the wrist and fingers. Lengthenings are more frequently performed than tendon transfers in the upper extremity. Arthrodesis of the wrist or on rare occasions of the metacarpal-phalangeal joints supplement the lengthenings when needed. Conclusions, The Penn Neuro-Orthopaedics Program has successfully treated adults with both residual and acquired musculoskeletal deformities. These deformities become more critical when combined with degenerative changes, a relative increase in body mass, fatigue, and weakness associated with the aging process. [source] Quantification of upper extremity function and range of motion in children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2008L Andrew Koman MD This study evaluated the hypothesis that upper extremity function and range of motion can be quantified reliably in children with cerebral palsy (CP) in a busy clinical setting. The specific aim was to determine the inter- and intrarater reliability of a modified House Functional Classification (MHC) system to evaluate upper extremity function and a standardized instrument to document upper extremity range of motion (Upper Extremity Rating Scale [UERS]). Sixty-five children with CP (43 males, 22 females, mean age 9y 2mo, SD 4y 1mo) with spasticity involving the upper extremity (quadriplegia n=22; hemiplegia n=36; diplegia n=7; Gross Motor Functional Classification System Levels I n=41, II n=6, III n=3, IV n=5, V n=10) were evaluated independently by occupational therapists and orthopedic surgeons using both instruments at several visits. Inter- and intrarater reliability were determined for both instruments by calculating measures of agreement (weighted kappa values and intraclass correlation coefficients [ICCs]). Interrater agreement (ICC=0.94) and intrarater agreement (ICC=0.96) on the MHC were good to excellent. Similarly, inter-rater agreement (kappa 0.66,0.81) and intrarater agreement (kappa 0.64,0.88) on the UERS was either good or excellent. The MHC and the UERS provide standardized, reliable, reproducible, and efficient instruments that can be used by occupational therapists and orthopedic surgeons to evaluate the upper extremities of children with CP. [source] The use of tiagabine in pediatric spasticity managementDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006Mary Lynn Chu MD Tiagabine, developed as an anti-epileptic medication, has the potential to reduce spasticity. The purpose of the present study was to assess the effectiveness of tiagabine in decreasing spasticity and improving the functional abilities of children with spastic cerebral palsy (CP). Nine children (seven females, two males) with CP (six spastic quadriplegia, three moderate to severe spastic diplegia) were treated with tiagabine for a mean of 7.2 months. Median age was 4y 5mo (range 3y 2mo-10y). All children were non-ambulatory. According to the Gross Motor Function Classification System, six were Level IV and three were Level V. Only one child showed a median decrease ,1.0 grade on the modified Ashworth scale in upper extremities, lower extremities, and overall. Another child had significant improvement in the Pediatric Evaluation of Disability Inventory Self-care score and improved feeding. None of the participants was found to have a significant improvement in motor function or a decrease in the number of motions (passive range of motion and muscle length test) that were limited. Reduction of nocturnal awakenings from painful spasms was reported in one child. Eight of the nine children experienced adverse side-effects during treatment. Although tiagabine was not found to be effective in decreasing children's spasticity or improving their function, its potential use in the relief of painful spasms associated with neurological conditions in the pediatric population warrants further investigation. [source] Immediate effect of percutaneous intramuscular stimulation during gait in children with cerebral palsy: a feasibility studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2005Margo N Orlin PT PhD PCS The feasibility of percutaneous intramuscular functional electrical stimulation (P-FES) in children with cerebral palsy (CP) for immediate improvement of ankle kinematics during gait has not previously been reported. Eight children with CP (six with diplegia, two with hemiplegia; mean age 9 years 1 month [SD 1y 4mo; range 7y 11mo to 11y 10mo]) had percutaneous intramuscular electrodes implanted into the gastrocnemius (GA) and tibialis anterior (TA) muscles of their involved limbs. Stimulation was provided during appropriate phases of the gait cycle in three conditions (GA only, TA only, and GA/TA). Immediately after a week of practice for each stimulation condition, a gait analysis was performed with and without stimulation. A significant improvement in peak dorsiflexion in swing for the more affected extremity and dorsiflexion at initial contact for the less affected extremity were found in the GA/TA condition. Clinically meaningful trends were evident for improvements in dorsiflexion kinematics for the more and less affected extremities in the TA only and GA/TA conditions. The results suggest that P-FES might immediately improve ankle kinematics in children with CP. [source] Relation between spasticity and strength in individuals with spastic diplegic cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2002Sandy A Ross MHS PT PCS The relation between spasticity and strength in individuals with cerebral palsy (CP) has not been extensively researched. Knee and ankle spasticity and strength were quantified in a retrospective analysis of 60 individuals with spastic diplegic CP (mean age 12 years, range 3 to 38) and a group of 50 individuals without disabilities (WD group; mean age 12 years, range 4 to 36). Spasticity was measured using a KinCom dynamometer that stretched the passive knee flexors or ankle plantarflexors at different speeds and recorded the amount of resistive torques. For the strength tests, the participant performed a maximum contraction of the knee flexors/extensors and ankle plantarflexors/dorsiflexors throughout their range of motion at a speed of 10/s on the dynamometer. Pearson's correlation coefficient was used to determine if a relation existed between spasticity and strength within the same muscle group and in opposing muscle groups at the knee and ankle joints. A t-test was performed to determine if greater spasticity and less strength existed at the ankles compared with the knees in those with CP. Results show that there was no relation between spasticity and strength either within the same muscle group or at opposing muscle groups at the knee and ankle joints in persons with CP. Individuals with spastic diplegic CP were more involved (greater spasticity, less strength) distally at the ankles compared with the knees. The findings conflict with the literature, which contains several assumptions, one of which is that a spastic muscle is a strong muscle and that spasticity causes weakness in the opposing muscle group. We found no relation between spasticity and strength in individuals with CP. Our findings support the literature, which states that individuals with spastic diplegic CP are more involved distally compared with proximally in the lower extremities. [source] Foot temperature in diabetic polyneuropathy: innocent bystander or unrecognized accomplice?DIABETIC MEDICINE, Issue 3 2005S. B. Rutkove Abstract Aim To explore mechanisms by which temperature could influence the pathogenesis and symptoms of diabetic polyneuropathy. Methods We conducted a literature review attempting to identify mechanisms by which diabetic polyneuropathy could be affected by temperature. Results Cooling can theoretically hasten the progression of diabetic polyneuropathy through several different mechanisms. Specifically, cooling can enhance neuronal ischaemia, increase formation of reactive oxygen species, slow axonal transport, increase protein kinase C activity, and interfere with immune function. Short-term temperature fluctuations (both warming and cooling) can initiate and exacerbate neuropathic pain by causing neuronal hyperexcitability and functional deafferentation. Although normal fluctuations of distal extremity temperature may be sufficient for these effects, impaired thermoregulation may make the distal extremities more susceptible to temperature extremes. Eventually, a ,vicious cycle' may ensue, resulting in neuronal deterioration with further disruption of temperature regulation. Limited epidemiological data suggest a higher prevalence of diabetic polyneuropathy in populations living in colder locations, supporting our hypothesis. Conclusions Variations in foot temperature may play an important but as yet unrecognized role in the development and symptoms of diabetic polyneuropathy. Further basic and clinical research exploring this concept could help elucidate the natural history of diabetic polyneuropathy and lead to novel therapeutic strategies. [source] Intrapancreatic schwannoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration cytologyDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2009Shaoying Li M.D. Abstract Schwannoma is a tumor of neuro-ectodermal origin, usually occuring in the head and neck and extremities. A retroperitoneal, and particularly intra-pancreatic presentation is very rare, and poses a clinical and diagnostic challenge. We report a case of a male patient who underwent an Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) biopsy of a hypoechoic, intra-pancreatic mass. The onsite cytological evaluation was consistent with a spindle cell neoplasm. Further evaluation, aided by immunohistochemical stains, defined the mass as a Schwannoma. The patient then underwent a pancreaticoduodenectomy and the histopathological diagnosis of the surgical specimen confirmed the cytological diagnosis. To our knowledge, this is the first report of intra-pancreatic Schwannoma diagnosed preoperatively by EUS-FNA cytology. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source] PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERYDIGESTIVE ENDOSCOPY, Issue 1 2003Kazuhiro Yada We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source] Cortical Resection with Electrocorticography for Intractable Porencephaly-related Partial EpilepsyEPILEPSIA, Issue 1 2005Koji Iida Summary:,Purpose: We evaluated the results of cortical resection of epileptogenic tissue for treatment of intractable porencephaly-related epilepsy. Methods: We examined clinical features, electrophysiological data, surgical findings, and seizure outcomes after cortical resection in eight patients with intractable epilepsy related to porencephalic cysts. Results: All eight patients had hemiparesis. Five retained motor function in the hemiparetic extremities; six retained visual fields. All had partial seizures, six with secondary generalization. Seven patients had simple and three had complex partial seizures (CPSs); two also had drop attacks. Four patients had multiple seizure types. Long-term scalp video-EEG (LVEEG) localized interictal epileptic abnormalities that anatomically corresponded to the cyst location in three patients. LVEEG recorded ictal-onset zones in five; these anatomically corresponded to the cyst location in three of the five. EEG recorded generalized seizures in two patients, hemispheric in one, and multifocal in two. Intraoperative electrocorticography (ECoG) revealed interictal epileptic areas extending beyond the margins of the cyst in seven patients. We resected ECoG-localized interictal epileptic areas completely in five patients and partially in two. Cortical resection was based on seizure semiology and LVEEG in one patient whose ECoG showed no epileptiform discharges. After a minimum follow-up of 1 year, six patients had excellent seizure outcome (Engel class I), and two had a >90% seizure reduction (Engel class III) without complications. Conclusions: Cortical resection guided by ECoG allows preservation of motor function and visual field and provides an effective surgical procedure for treatment of intractable epilepsy secondary to porencephaly. [source] | ||||||||||||||||||||||||||||||||||||||||