Delayed recovery of the affected finger extensors at chronic stage in a stroke patient: A case report.

RATIONALE: A 33-year-old male presented with complete weakness of the right extremities due to corona radiata infarct. PATIENT CONCERNS: The main concerns of the patient is recovery of hand function especially related to finger extension. DIAGNOSES: Right corona radiata infarct. INTERVENTIONS: He underwent physical therapy and occupational therapy at the outpatient clinic of the rehabilitation department of the same university hospital until 2 years after onset. In addition, he underwent neuromuscular electrical stimulation for the right finger extensors continuously until 4 years after onset. OUTCOMES: At 6 months after onset, the weakness of his right side recovered to subnormal state except for the right finger extensors which were completely weak. At 1.5 years after onset, the right finger extensors began to show slow and continuous recovery. At 4 years after onset, the patient showed motor recovery in the right finger extensors to the extent that he was able to move against gravity. Discontinuation of the left corticospinal tract was observed on 2-month diffusion tensor tractography (DTT); however, the integrity of this discontinuation had recovered to the primary motor cortex on 4-year DTT. On 2-month transcranial magnetic stimulation (TMS), no motor-evoked potential was evoked; in contrast, motor-evoked potentials were obtained at the right-hand muscle on 4-year TMS study. LESSONS: We demonstrated unusual delayed and long-term recovery of the affected finger extensors in a patient with corona radiata infarct using DTT and TMS.

[Effects of a combined weight-bearing and non-weight-bearing ( warm water) exercise program on bone mass and quality in postmenopausal women with low bone-mineral density]. / Effetti di un programma combinato di esercizio con e senza sovraccarico (acqua termale) sulla massa e qualità ossea in un gruppo di donne in età post-menopausale con deficit minerale osseo.

AIMS: To evaluate the effects of a combined weight- and non weight-bearing (water) exercise program on bone mass and quality in postmenopausal women with low bone mineral density. MATERIALS AND METHODS: 125 post-menopausal women with osteopenia/osteoporosis underwent a bone mass (Dual-Energy X-ray Absorbimetry, DEXA) and bone tissue quality (phalangeal osteosonography) evaluation. 58 of the participants took part in an 11-month specific exercise program (E). The other represented a control group (C) that did not exercise. At the end of the exercise program all the participants were re-evaluated. RESULTS: Concerning bone mass, within and between groups data analysis showed that t-score, measured at neck of femur, significantly increased in E (p < 0.05). No differences were instead detected for all the other parameters. With respect to osteosonography, group C showed a significant decrease of all bone quality parameters (p < 0.05), whereas E showed no differences after the exercise program. CONCLUSIONS: The results showed that a specific exercise program targeting osteoporosis is useful to reduce the physiological bone loss and to maintain a good bone quality in a group of postmenopausal women with low bone mineral density.

Functional neuroanatomical networks associated with expertise in motor imagery.

Although numerous behavioural studies provide evidence that there exist wide differences within individual motor imagery (MI) abilities, little is known with regards to the functional neuroanatomical networks that dissociate someone with good versus poor MI capacities. For the first time, we thus compared, through functional magnetic resonance imaging (fMRI), the pattern of cerebral activations in 13 skilled and 15 unskilled imagers during both physical execution and MI of a sequence of finger movements. Differences in MI abilities were assessed using well-established questionnaire and chronometric measures, as well as a new index based upon the subject's peripheral responses from the autonomic nervous system. As expected, both good and poor imagers activated the inferior and superior parietal lobules, as well as motor-related regions including the lateral and medial premotor cortex, the cerebellum and putamen. Inter-group comparisons revealed that good imagers activated more the parietal and ventrolateral premotor regions, which are known to play a critical role in the generation of mental images. By contrast, poor imagers recruited the cerebellum, orbito-frontal and posterior cingulate cortices. Consistent with findings from the motor sequence learning literature and Doyon and Ungerleider's model of motor learning [Doyon, J., Ungerleider, L.G., 2002. Functional anatomy of motor skill learning. In: Squire, L.R., Schacter, D.L. (Eds.), Neuropsychology of memory, Guilford Press, pp. 225-238], our results demonstrate that compared to skilled imagers, poor imagers not only need to recruit the cortico-striatal system, but to compensate with the cortico-cerebellar system during MI of sequential movements.

Hand involvement in Schmid metaphyseal chondrodysplasia.

Schmid metaphyseal chondrodysplasia (Schmid MCD, MIM 156500) is caused by mutations in the COL10A1 gene and is clinically characterized by short stature, bowed legs, and a waddling gait. Radiographic findings include anterior cupping, sclerosis and splaying of the ribs, diffuse metaphyseal flaring, and irregularity that is most pronounced at the knees, coxa vara, and femoral bowing. We reviewed the radiographs of Schmid MCD patients at the International Skeletal Dysplasia Registry in Los Angeles for evidence of hand involvement. We found hand involvement in 47% (7/15) of cases included in our analysis. These changes were subtle and consisted of shortening of the tubular bones and metaphyseal cupping of the proximal phalanges and metacarpals. Mild hand involvement is a common feature of Schmid MCD.

Epinephrine in digital block: color Doppler flow imaging.

BACKGROUND: Epinephrine is currently added to local anesthetics for its advantageous vasoconstrictive effects. Traditionally, however, its use is not advised for digital block anesthesia due to the risk of digital gangrene. OBJECTIVE: To observe vasoconstrictive effect of epinephrine in digital block anesthesia. METHODS: Digital blocking with epinephrine containing lidocaine was performed in 24 subjects undergoing surgical procedure of their finger and toes. Digital artery blood flows were studied with color Doppler ultrasonography before digital blocking and at 10th, 60th, and if needed 90th minutes after blocking. Doppler parameters such as peak systolic velocity, end diastolic velocity, and resistive index values were studied. RESULTS: There were statistically significant decrease of blood flow rates and an increase of resistive index in all patients within 10 minutes. At the 10th minute of digital block, four patients had no measurable blood flow, which was restored within 60 or 90 minutes. Others showed diminished but persistent blood flow, which returned to normal within 60 minutes. No systemic or local complication related with epinephrine usage was observed. CONCLUSION: Vasoconstrictive effect of epinephrine in local anesthetics is not persistent and resolves within 60 or 90 minutes. Its use seems to be safe in selected patients.

Influence of vitamin D administration on bone ultrasound measurements in patients on anticonvulsant therapy.

BACKGROUND: The objective of the study was to evaluate bone mass status (as measured by bone ultrasound) in patients on anticonvulsant therapy, and the influence that Vitamin D administration exerts over it. MATERIALS AND METHODS: We measured and compared the basal serum levels of 25(OH)D3, parathyroid hormone (PTH), and phalangeal bone ultrasound (Ad-SOS), in 30 adult patients who were taking anticonvulsant drugs, with a control group of similar age and sex. We then gave the patients a large oral dose of 3 mg (120.000 UI) of 25(OH)D3, and repeated the measurements after one month. RESULTS: Basal 25(OH)D3 and Ad-SOS values were significantly lower, and PTH values significantly higher (P< 0.0001 in all), in the patient group. The low Ad-SOS values for the patients were independent of the treatment, but directly related to basal 25(OH)D3 levels (r = 0.45, P<0.01). There was a negative association between PTH and 25(OH)D3 (r = -0.64, P<0.0001), and no correlation between PTH y Ad-SOS (r = -0.20, p NS). After ingestion of the large dose of the vitamin D, the patient group registered a significant (P<0.0001) increase in 25(OH)D3 levels, their Ad-SOS values increased (P<0.0001) nearly to the mean basal value of the control group, and PTH decreased significantly (P<0.0001). CONCLUSIONS: These findings justify the need to assure adequate vitamin D intake in patients being treated with anticonvulsants, independently of the treatment, age, sex, and activity status, in order to prevent osteomalacia.

Rotational Salter-Harris type 1 fracture of the proximal phalanx.

A purely rotational Salter-Harris type I fracture of the proximal phalanx of the middle finger is described. This injury presents diagnostic problems as the radiographs do not show the displacement. Accurate clinical examination is essential, in particular checking for rotation of the finger.

[Comparison of diagnostic methods for osteoporosis in endogenous hypercorticism]. / Sravnitel'naia kharakteristika metodov diagnostiki osteoporoza pri éndogennom giperkortitsizme.

The informative value of diagnosis of osteoporosis in 53 patients with Itsenko-Cushing disease was assessed by visual estimation of radiograms of the axial skeleton, standard x-ray densitometry of the phalanges of the thumbs and single-photon absorptiometry of the distal parts of antebrachial bones. Diagnosis of osteoporosis and its evaluation over time were shown to be accurate in combination of visual assessment of radiograms of the axial skeleton with standard x-ray densitometry of the peripheral parts of the skeleton. Single-photon absorptiometry revealed no decrease in the level of the osseous mineral in the forearm of patients with endogenous hypercorticoidism. In the majority of female patients this indicator even exceeded the normal age value. Possible causes of this phenomenon are under discussion.

On the treatment of enchondroma.

We recommend simply removing an enchondroma without filling the cavity with cancellous bone or plaster-of-Paris. This method can also be applied to other benign bone conditions, such as aseptic necrosis.

Effect of pregnancy on the lamina dura.

Serum chemistry studies and radiological examination of the lamina dura and phalanges were conducted in 50 pregnant women, 25 of whom had been administered calcium and vitamin D supplements during the 3rd trimester. The non-supplemented pregnant women showed significant hypocalcaemia, elevated serum heat-labile alkaline phosphatase activity, and resorption of the lamina dura. The supplemented group of pregnant women also showed resorption of the lamina dura, although the serum chemistry was essentially normal. It is suggested that, probably because of gestational hyperparathyroidism, mild resorption of the lamina dura may be a feature of normal pregnancy.

Osteoporosis in postmenopausal women.

Eleven postmenopausal complete denture patients participated in a study to evaluate some possible predictors of osteoporosis. Most participants in the study reported a low caloric intake and consumed considerably less than the recommended daily allowances of sodium, cholesterol, calcium, fluoride, magnesium, zinc, and folic acid. Many participants in the study were taking additional daily vitamin and mineral supplements. The CCT as measured on radiographs of the second phalynx of the fifth digit of the right hand correlated linearly with the CBD corrected for soft tissue. Panoramic radiographs revealed that all individuals had severe residual ridge resorption. All serum calcium and phosphorus means were within the normal range, while more than 60% of the patients had below normal plasma levels of 25-hydroxyvitamin D. In conclusion, although based on a small sample, it appears that the diet of elderly women in New York is somewhat deficient for adequate skeletal homeostasis. Ideally, the vitamin D status of each patient should be determined and proper supplements prescribed. However, the high cost of analysis suggests that dietary analysis be used on a selected but more frequent basis. Radiation techniques for measuring skeletal porosity are also too complex to perform on a routine basis and should, like dietary analysis, be reserved for patients in whom other clinical signs and symptoms indicate metabolic bone disease.

Treatment of calcinosis circumscripta with probenecid.

A 23-year-old woman presented with an 11-year history of peripheral joint pains and stiffness slowly progressing to the development of gross calcinosis circumscripta. She had no definite evidence of systemic scleroderma. She was first treated for one year with frequent intravenous sodium EDTA, which increased urinary calcium and enhanced negative calcium balance but did not lessen her calcinosis. She was then treated with probenecid up to 2 g daily and her calcinosis lessened steadily over three years. Plasma levels of both phosphorus and urate fell during this time.