RESUMEN
Individuals with cerebral palsy (CP) participate in reduced levels of physical activity and spend an increased amount of time in a sedentary state compared with healthy control subjects. Whether this in part can be explained by impaired muscle function is still unclear. The aim of the present study was to elucidate differences in muscle fibre recruitment during treadmill exercise between CP subjects and healthy age-, sex- and BMI-matched controls. This is a case-control study. Acoustic myography (AMG), a method recording fibre use and efficiency from contracting muscles, was applied during a period of treadmill exercise. The recorded AMG parameters revealed that the CP subjects had a significantly lower initial S-score (spatial summation) than the controls (P < 0.01). However, the T-score (temporal summation) and the E-score (efficiency) showed no significant differences between individuals with CP and the healthy control subjects. The present findings indicate that CP subjects use a higher degree of spatial summation (more fibres recruited) to keep up the same speed during treadmill exercise when compared to healthy matched control subjects. Our results suggest that individuals with CP have a tendency to recruit far more muscle fibres during bouts of exercise than healthy individuals. This may partly explain why CP subjects experience premature fatigue.
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Parálisis Cerebral/fisiopatología , Ejercicio Físico , Músculo Esquelético/fisiopatología , Miografía , Adulto , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: The aim was to assess the anatomical distribution of acute deep venous thrombosis (DVT) with a focus on iliofemoral DVT, and, in particular, to characterise thrombus in the common femoral vein (CFV) and the deep femoral vein (DFV). METHODS: A one year prospective study including patients older than 18 years of age with an acute first time DVT according to ultrasound examination at one of three university hospitals in Copenhagen, Denmark. Thrombus location and extent were registered and divided into five segments: calf veins; popliteal vein; femoral and deep femoral vein; common femoral vein; and iliac veins and/or the inferior vena cava. Thrombus appearance of the CFV and the DFV (partial or occlusive) was examined in detail. RESULTS: Acute DVTs were identified in 203 extremities in 200 patients (58% male). The median age of the patients was 68 years (range 19-92 years), and left-sided DVT was observed in 56%. Iliofemoral DVT was present in 54 (27.0%) patients. Thrombus involving the CFV but not the iliac veins (CFV group) was seen in 28 patients; the remaining 26 had involvement of the iliac veins (iliac group). Thrombus in the CFV was more likely to be occlusive in the iliac group than in the CFV group (77% vs. 4%; p < .001). Thrombus in the DFV was more often occlusive in the iliac group than in the CFV group (81% vs. 11%; p < .001). The DFV was free of thrombus in 12% of patients in the iliac group and in 64% of those in the CFV group. CONCLUSION: The presence of occlusive thrombus in the CFV and/or in the DFV pointed to a DVT also involving the ipsilateral iliac veins. Thrombosis of the deep leg veins extending into the CFV below the inguinal ligament was more likely to be partial in the CFV, mainly due to inflow from the DFV.
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Vena Femoral/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Ultrasonografía Doppler en Color , Trombosis de la Vena/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Dinamarca , Femenino , Vena Femoral/fisiopatología , Hemodinámica , Humanos , Vena Ilíaca/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Trombosis de la Vena/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Measurement of the ankle and toe pressures are often performed using a plethysmograph, compression cuffs and a strain gauge. Usually, the strain gauge contains mercury but other alternatives exist. From 2014, the mercury-containing strain gauge will no longer be available in the European Union. The aim of this study was to compare an indium-gallium strain gauge to the established mercury-containing strain gauge. METHODS: Consecutive patients referred to the Department of Clinical Physiology and Nuclear Medicine at Bispebjerg and Frederiksberg Hospitals for measurements of systolic ankle and toe pressures volunteered for the study. Ankle and toe pressures were measured twice with the mercury and the indium-gallium strain gauge in random order. Comparison of the correlation between the mean pressure using the mercury and the indium-gallium device and the difference between the two devices was performed for both toe and ankle level. RESULTS: A total of 53 patients were included (36 male). Mean age was 69 (range, 45-92 years). Mean pressures at toe and ankle level with the mercury and the indium-gallium strain gauges were 77 (range, 0-180) mm Hg and 113 (range, 15-190) mm Hg, respectively. Comparison between the mercury and the indium-gallium strain gauge showed a difference in toe blood pressure values of - 0.7 mm Hg (SD: 7.0). At the ankle level, a difference of 2.0 mm Hg (SD: 8.6) was found. CONCLUSION: The two different devices agree sufficiently in the measurements of systolic ankle and toe pressure for the indium-gallium strain gauge to replace the mercury strain gauge.
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Tobillo , Equipos y Suministros , Enfermedad Arterial Periférica/diagnóstico , Sístole , Dedos del Pie , Galio , Humanos , Indio , Mercurio , Enfermedad Arterial Periférica/fisiopatologíaRESUMEN
[18F]Fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used to demonstrate inflammation in specific sites typical for polymyalgia rheumatica (PMR). Scoring systems based on FDG uptake have been proposed to increase diagnostic accuracy. METHODS: Retrospective inclusion of 198 consecutive patients ≥40 years of age referred for FDG-PET from the Department of Rheumatology. We assessed the degree of FDG uptake in predilection sites visually, as well as semiquantitatively, and through logistic regression analyses, we evaluated the performance of existing scoring systems as well as a new, simplified scoring system, against the final clinical diagnosis at 6 months after the FDG-PET scan. RESULTS: We found high diagnostic accuracy for the diagnosis of PMR (range 0.74-0.91) using most of the existing scoring systems in glucocorticoid-naïve patients. A simplified scoring system including only periarticular FDG uptake in the shoulders and the ischiogluteal bursae retained high sensitivity and specificity (0.92 and 0.86, respectively). We found a detrimental effect on diagnostic accuracy in all scoring systems in patients treated with glucocorticoids within 4 weeks prior to FDG-PET. CONCLUSION: Most FDG-PET scoring systems perform well for the diagnosis of PMR, and there is no loss of either sensitivity or specificity in the simplest scoring systems evaluating FDG uptake in only a few selected anatomical regions. However, systemic glucocorticoid treatment up to 4 weeks prior to FDG-PET has a markedly detrimental effect on the diagnostic accuracy of all scoring systems.
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BACKGROUND: Postthrombotic syndrome (PTS) is a common complication after iliofemoral venous thrombosis, often resulting in poor quality of life (QOL) among the affected patients. This study assessed development of PTS and its effect on QOL among patients treated for iliofemoral venous thrombosis by catheter-directed thrombolysis. METHODS: Patients admitted with an iliofemoral venous thrombosis and treated with catheter-directed thrombolysis at Gentofte University Hospital from 1999 to 2008 were invited to participate. Duplex ultrasound imaging was used to assess venous patency and valve function. Each patient completed the generic Short-Form 36-item (SF-36) health survey assessment, producing physical component (PCS) and mental component summary (MCS) scores, and the disease-specific Venous Insufficiency Epidemiological and Economic Study (VEINES)-Quality of Life (QOL)/Symptoms (Sym), questionnaires to assess QOL. PTS was assessed using the Villalta scale. RESULTS: The study included 109 patients. Median follow-up was 71 months. PTS developed in 18 patients (16.5%) and of those, initial thrombolysis was successful in 13. Patients with PTS had significantly worse mean ± standard deviation scores than patients without PTS on VEINES-QOL (34.2 ± 9.6 vs 53.1 ± 6.6; P < .0001), VEINES-Sym (34.0 ± 8.8 vs 53.2 ± 6.6; P < .0001), SF-36 MCS (44.2 ± 15.5 vs 52.3 ± 11.0; P = .005), and SF-36 PCS (42.3 ± 9.1 vs 53.5 ± 7.8; P < .0001) subscales. Patients with reflux or chronic occlusions, or both, had significantly lower mean ± SD scores than patients with patent veins without reflux on VEINES-QOL (43.5 ± 14.3 vs 51.0 ± 8.8; P = .044) and SF-36 PCS (47.2 ± 10.9 vs 52.4 ± 8.5; P = .049) scales. CONCLUSION: PTS was associated with worse QOL, although only a few patients developed PTS after catheter-directed thrombolysis of iliofemoral venous thrombosis. Patients with patent veins and sufficient valves have higher QOL scores than patients with reflux and occluded veins.
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Vena Femoral , Vena Ilíaca , Síndrome Postrombótico/etiología , Calidad de Vida , Terapia Trombolítica , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Adolescente , Adulto , Catéteres , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Terapia Trombolítica/instrumentación , Adulto JovenRESUMEN
PURPOSE: To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT). MATERIALS AND METHODS: From 2001 to 2009, 11 patients (median age, 32 y) with atresia of the IVC and acute iliofemoral DVT in 13 limbs were admitted for catheter-directed thrombolysis. Through a multiple-side hole catheter inserted in the popliteal vein, continuous pulse-spray infusion of tissue plasminogen activator and heparin was performed. Thrombolysis was terminated when all thrombus was resolved and venous outflow through the paravertebral collateral vessels was achieved. After thrombolysis, all patients received lifelong anticoagulation and compression stockings and were followed up at regular intervals. RESULTS: Ultrasound or computed tomography revealed absence of the suprarenal segment of the IVC in two patients, and nine were diagnosed with absence of the infrarenal segment of the IVC. Median treatment time was 58 hours (range, 42-95 h). No deaths or serious complications occurred. Overall, complications were observed in four patients, one of whom required blood transfusion. Three patients were diagnosed with thrombophilia. Median follow-up was 37 months (range, 51 d to 96 mo). All patients had patent deep veins and one developed reflux in the popliteal fossa after 4 years. No thromboembolic recurrences were observed during follow-up. CONCLUSIONS: Catheter-directed thrombolysis of patients with acute iliofemoral DVT and atresia of the IVC is a viable treatment option, as reasonable clinical outcomes can be obtained.
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Cateterismo Periférico , Vena Femoral , Fibrinolíticos/administración & dosificación , Vena Ilíaca , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Malformaciones Vasculares/complicaciones , Vena Cava Inferior/anomalías , Trombosis de la Vena/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Anticoagulantes/administración & dosificación , Dinamarca , Femenino , Vena Femoral/diagnóstico por imagen , Fibrinolíticos/efectos adversos , Heparina/administración & dosificación , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Flebografía , Vena Poplítea , Estudios Retrospectivos , Medias de Compresión , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía , Malformaciones Vasculares/diagnóstico , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Warfarina/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Use of 11C-Choline PET/CT is gaining ground in detecting hyperfunctioning parathyroid glands in primary hyperparathyroidism. The purpose of this study was to evaluate the robustness of 11C-Choline PET/CT by assessing intra- and inter-observer agreement to determine whether the method was reader sensitive and therefore should only be performed at highly specialised sites with a high number of cases. PET/CT images of 40 patients diagnosed with primary hyperparathyroidism were anonymised and evaluated three times by three readers: an expert reader and two non-experts (non-experts were experienced in PET/CT imaging, but not in 11C-Choline PET/CT in the setting of primary hyperparathyroidism). Number of hyperfunctioning parathyroid glands, location relative to the thyroid gland and confidence of each assessment (low, moderate or high) were noted, and intra- and inter-observer agreement calculated using Fleiss' kappa method. Sensitivities and specificities of the non-experts were calculated using the expert reader as gold standard. RESULTS: Intra-observer agreement was 'good' to 'near perfect' for all readers. Inter-observer agreement was good between non-experts and the expert, with kappa values ≥ 0.74. Sensitivities between non-experts and the expert were high, > 81%, when assessing which side and 75% when assessing thyroid quadrant. All specificities were > 94%. Reader certainties were 'high' in > 80% of cases for the expert and > 70% and > 65%, respectively for the two non-experts. CONCLUSION: 11C-Choline PET/CT is not reader sensitive for the localisation of hyperfunctioning parathyroid glands and may therefore be safely implemented at sites that have a moderate number of cases. Access to a cyclotron laboratory is, however, a necessity for the production of 11C-Choline. The study was conducted in accordance with the Helsinki 2 declaration and The International Council for Harmonisation Guideline for Good Clinical Practice (ICH_GCP) clinical trial, approved by the Research Ethics Committee of the Capital Region of Denmark (Journal-nr.:H-18012490, date of approval: 18 June 2018) and the Danish Medicines Agency (EudraCT no. 2018-000726-63, date of approval: 6 June 2018). The GCP unit in Eastern Denmark has carried out regular monitoring of the trial according to GCP (ID: 2018-1050).
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Muscle contractures are a common complication in patients with central nervous system (CNS) lesions which limit range of movement and cause joint deformities. Furthermore, it has previously been shown that muscles with contractures have a reduced number of capillaries, indicating decreased tissue vascularization. The aim of the present study was to investigate the microvascular volume (MV) at rest and after acute exercise in the muscle tissue of individuals with cerebral palsy (CP) and healthy control individuals. Contrast-enhanced ultrasound (CEUS) was used before and after 30 min of walking or running on a treadmill in 10 healthy control participants and 10 individuals with CP to detect MV of their skeletal muscle tissue. A significant increase in the MV was observed after exercise both in the adult CP group (21-53 yr) and in the control group (21-52 yr) (1.8 ± 0.8 ΔdB to 3.1 ± 0.9 ΔdB or 42.9% and 1.5 ± 0.6 ΔdB to 2.5 ± 0.9 ΔdB or 39.0%, respectively). Furthermore, a difference in the resting MV was observed between the most severe cases of CP [gross motor function classification scale (GMFCS) 3 and 4] (2.3 ± 0.5 ΔdB) and the less severe cases (GMFCS 1 and 2) (1.5 ± 0.2 ΔdB). When the CP group was walking (3.4 km/h), the lactate levels, Borg score, and heart rate matched the level of controls when they were running (9.8 km/h). In conclusion, individuals with CP become exhausted at much lower exercise intensities than healthy individuals. This is not explained by impaired microvascularization, since the MV of the individuals with CP respond normally to increased O2 demand during acute exercise. NEW & NOTEWORTHY Cerebral palsy (CP) patients were less physically active compared with typically developed individuals. This may affect the microvascularization. We observed that the CP group became exhausted at much lower exercise intensities compared with healthy individuals. However, impaired microvascularization was not the reason for the decreased physical activity as the CP group responded normally to increased O2 demand during acute exercise. These results indicate that walking may be recommended as an intervention to train and maintain skeletal muscle tissue in individuals with CP.
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Parálisis Cerebral/fisiopatología , Ejercicio Físico/fisiología , Microvasos/fisiopatología , Neovascularización Fisiológica/fisiología , Adulto , Estudios de Casos y Controles , Prueba de Esfuerzo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Carrera/fisiología , Caminata/fisiología , Adulto JovenAsunto(s)
Fibrinolíticos/uso terapéutico , Trastornos Puerperales/terapia , Trombosis de la Vena/terapia , Adulto , Anticoagulantes/uso terapéutico , Cateterismo , Femenino , Vena Femoral , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Trastornos Puerperales/diagnóstico , Stents , Activador de Tejido Plasminógeno/uso terapéutico , Filtros de Vena Cava , Trombosis de la Vena/diagnósticoRESUMEN
Paget disease (PD) of bone is a benign but chronic disorder of bone metabolism. We report a case of an 85-year-old man with several fractures in the pelvis and radiograph raising suspicion of metastases. An F-NaF PET/CT demonstrated high F-NaF uptake in the same regions. The integrated assessment of imaging findings, supported by biochemistry, allowed diagnosing PD. The F-NaF PET/CT is a supplementary diagnostic instrument in the diagnosis of PD, and use of F-NaF PET/CT in this context, especially finalized to the differential diagnosis with metastatic lesions, requires the physician to be familiar with imaging patterns of this disease.
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Radioisótopos de Flúor , Osteítis Deformante/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Fluoruro de Sodio , Anciano de 80 o más Años , Transporte Biológico , Humanos , Masculino , Osteítis Deformante/metabolismo , Fluoruro de Sodio/metabolismoRESUMEN
Chronic compartment syndrome is a challenge for the clinician and symptomatic similar to neuropathies, tenosynovitis, stress fractures and referred pain from lumbar cervicalis. Thus, chronic compartment syndrome of the upper extremities is probably an underdiagnosed condition. In patients with stress-induced pain in the upper limbs, chronic compartment syndrome should be considered - particularly in young patients with high physical activity. Despite limited literature, the effect of surgical treatment is promising.
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Síndromes Compartimentales/diagnóstico , Antebrazo/irrigación sanguínea , Adulto , Síndromes Compartimentales/patología , Síndromes Compartimentales/cirugía , Antebrazo/patología , Humanos , MasculinoRESUMEN
Treatment of acute iliofemoral deep venous thrombosis (DVT) with catheter-directed thrombolysis (CDT) has been performed in Denmark since 1999. The purpose of CDT is to dissolve thrombus and to restore the venous lumen as fast as possible and thereby save venous valve function and prevent postthrombotic syndrome. Danish studies have shown that treatment of acute iliofemoral DVT using CDT results in good patency, preserves venous valve function, reduces the frequency of PTS, and is associated with a higher quality of life.
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Cateterismo Periférico , Vena Femoral , Vena Ilíaca , Síndrome Postrombótico/prevención & control , Terapia Trombolítica/métodos , Trombosis de la Vena/tratamiento farmacológico , Enfermedad Aguda , Anticoagulantes/administración & dosificación , Fibrinolíticos/administración & dosificación , Humanos , Síndrome Postrombótico/etiología , Guías de Práctica Clínica como Asunto , Stents , Terapia Trombolítica/efectos adversos , Trombosis de la Vena/complicacionesRESUMEN
INTRODUCTION: Proximal deep venous thrombosis (DVT) often leads to venous outflow obstruction in chronic venous insufficiency (CVI). This paper presents our clinical experience with iliac vein stent placement. MATERIALS AND METHODS: Between January 2001 and November 2004 balloon dilation and stent placement for the relief of iliac vein obstruction was intended in ten patients suffering from venous claudication. Median age was 35 years (range 21-42). Eight patients had earlier been treated for proximal DVT on the left side and two patients had May-Thurner syndrome. Ultrasound scanning was performed on all patients for the detection of iliac vein obstruction. It was a requirement that all patients had an open deep venous system without reflux distally to the occlusion. The procedure was carried out under local anaesthesia and all patients were anticoagulated postoperatively. RESULTS: There was one technical failure and nine patients were treated successfully. In one of these patients the stent rethrombosed after two days but the thrombus was lysed and the patient was restented more distally. All patients were discharged with an open venous system. At follow-up, eight of the nine stents were patent. Five patients had normal walking distance and three had improved. The median follow-up time was 32.5 months (range 6-53 months). CONCLUSION: The correction of iliac vein obstruction with the placement of stents in patients with venous claudication seems to be an effective, safe method which is minimally invasive. Short term patency is satisfactory but the long term results of stents in the venous system are not known and longer follow-up is required.