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1.
Am Surg ; 86(2): 104-109, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167051

RESUMO

Deep vein thrombosis (DVT) is linked to reimbursements and publicly reported metrics. Some hospitals discourage venous duplex ultrasound (VDUS) screening in asymptomatic trauma patients because they often find higher rates of DVT. We aim to evaluate the association between lower extremity (LE) VDUS screening and pulmonary embolism (PE) in trauma patients. Trauma patients admitted to an urban Level-1 trauma center between 2010 and 2015 were retrospectively analyzed. We characterized the association of asymptomatic LE VDUSs with PE, upper extremity DVT, proximal LE DVT, and distal LE DVT by univariate and multivariable logistic regression controlling for confounders. Of the 3959 trauma patients included in our study-after adjusting for covariates related to patient demographics, injury, and procedures-there was a significantly lower likelihood of PE in screened patients (odds ratio (OR) = 0.02, P < 0.001) and a higher rate of distal LE DVT (OR 11.1, P = 0.004). Screening was not associated with higher rates of proximal LE DVT after adjustment for covariates (OR = 1.8, P = 0.193). PE was associated with patient transfer status, pelvis fracture, and spinal procedures in unscreened patients. After adjusting for covariates, we have shown that LE VDUS asymptomatic screening is associated with lower rates of PE in trauma patients and not associated with higher rates of proximal LE DVT. Our detailed institutional review of a large cohort of trauma patients over five years provides support for ongoing asymptomatic screening and better characterizes venous thromboembolism outcomes than similarly sized purely administrative data reviews. As a retrospective cohort study with a large sample size, no loss to follow-up, and a population with low heterogeneity, this study should be considered as level III evidence for care management.


Assuntos
Doenças Assintomáticas , Embolia Pulmonar/diagnóstico por imagem , Tromboembolia Venosa/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Ferimentos e Lesões/complicações , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Razão de Chances , Embolia Pulmonar/complicações , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Ultrassonografia Doppler Dupla/estatística & dados numéricos , Tromboembolia Venosa/complicações , Trombose Venosa/complicações
2.
Muscle Nerve ; 61(4): 496-503, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31953869

RESUMO

BACKGROUND: Fat infiltration in individual muscles of sporadic inclusion body myositis (sIBM) patients has rarely been assessed. METHODS: Sixteen sIBM patients were assessed using MRI of the thighs and lower legs (LL). The severity of fat infiltration, proximal-to-distal and side asymmetries, and the correlations with clinical and functional parameters were investigated. RESULTS: All the patients had fat-infiltrated muscles, and thighs were more severely affected than LL. A proximal-to-distal gradient of fat infiltration was mainly observed for adductors, quadriceps, sartorius, and medial gastrocnemius muscles. A strong negative correlation was observed between the whole muscle fat fraction in the thighs and LL and the Inclusion Body Myositis Functional Rating Scale and Medical Research Council scores for the lower limbs. CONCLUSIONS: Fat infiltration in individual muscles of sIBM patients is heterogeneous in terms of proximal-to-distal gradient and severity was correlated with clinical scores. These results should be considered for both natural history investigation and clinical trials.


Assuntos
Imagem por Ressonância Magnética/métodos , Músculo Esquelético/diagnóstico por imagem , Miosite de Corpos de Inclusão/diagnóstico por imagem , Coxa da Perna/diagnóstico por imagem , Idoso , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
3.
J Comput Assist Tomogr ; 44(1): 20-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939877

RESUMO

OBJECTIVES: The purpose of this study was to evaluate whether quantitative analysis of lower leg muscle enhancement measured from dynamic computed tomographic angiography (dyn-CTA) could be used for diagnosis of peripheral arterial occlusive disease. METHODS: Patients (N = 35) with known peripheral arterial occlusive disease underwent the dyn-CTA of calves first. Five minutes later, standard CTA of the peripheral runoff from the diaphragm to the toes was performed. A runoff score was assigned by radiologists as a reference standard for each of 4 lower leg artery segments. The lower leg muscle enhancement measured from the dyn-CTA was analyzed by using quantitative kinetic parameters, including initial enhancement (E1), peak enhancement (Epeak), and enhancement ratio (ER) calculated from average time attenuation curves. In addition, histogram of lower leg muscle enhancement was evaluated by using the first enhanced phase images. RESULTS: Lower extremities were diagnosed as a normal group (n = 22) with each vessel segment score equals to 1 or lower and runoff score, 7 or lower, and otherwise as an ischemia group (n = 48). Average ± SD E1 is 91.4% ± 8.5% and 82.3% ± 10.7%, Epeak is 122.7% ± 10.4% and 115.6% ± 11.1%, and ER is 0.75 ± 0.05 and 0.72 ± 0.09 for normal and ischemia group, respectively. Statistical analysis showed that average E1 and Epeak for the ischemia group were significantly lower (P < 0.05) than the normal group. The histogram analysis demonstrated that mean and median of muscle enhancement in the ischemia group were significantly smaller (P < 0.05), and coefficient of variation (CV) was significantly larger (P < 0.05) than the normal group. There were weak negative correlations (r = -0.42, P < 0.05) between runoff scores and E1 and Epeak, and weak positive correlation (r = 0.40, P < 0.05) between runoff scores and CV. The receiver operating characteristics analysis between the 2 groups had area under the curve of 0.77 and 0.76 for E1 and CV, respectively. CONCLUSIONS: Lower leg muscle enhancement measured from the dyn-CTA could be assessed quantitatively to assist diagnosis of ischemia in clinical practice.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Extremidade Inferior/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação
4.
Acta Orthop ; 91(2): 171-176, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31960731

RESUMO

Background and purpose - Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration.Patients and methods - 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test-retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test-retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model's predictions were compared with clinical outcomes and a confusion matrix was generated.Results - 6 of 8 reviewers had non-significant intra-rater ICCs for ≥ one parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52-100) and 87% (CI 74-94) respectively. The decision tree demonstrated 100% (CI 40-100) sensitivity and 89% (CI 75-96) specificity with the test cohort.Interpretation - A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseo-integration implants.


Assuntos
Interface Osso-Implante/diagnóstico por imagem , Árvores de Decisões , Extremidade Inferior/cirurgia , Osseointegração , Falha de Prótese/etiologia , Estudos de Coortes , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Hiperostose , Extremidade Inferior/diagnóstico por imagem , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Prognóstico , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Radiografia/métodos , Sensibilidade e Especificidade , Estresse Mecânico
5.
J Cardiothorac Surg ; 15(1): 10, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918763

RESUMO

BACKGROUND: Lower limb malperfusion accompanied with acute type A dissection (AAD) is reported to be an independent predictor for mortality. Timely treatment is required. However, staged approach to restore the perfusion of the ischemic leg before aortic repair has a continuously increase risk of aortic rupture. Aortic repair under isolated axillary artery perfusion also has the risk of prolonging leg ischemia. Here we introduce our experience in performing axillo-femoral perfusion, which is supposed to bring benefits for treating lower limb malperfuison. METHODS: Thirty patients who suffered AAD accompanied by lower limb ischemia enrolled in our study. All patients received aortic repair as soon as possible using the modified axillo-femoral perfusion approach. The cardiopulmonary bypass and cooling started with the right axillary artery perfusion. Then the femoral artery of the ischemic side was exposed and sewn to a graft connected with another inflow cannula. The rectal temperature was about 31 °C when the femoral perfusion started. The perfusion of the ischemic legs preoperative was estimated after the surgery by the clinical signs, the saturation of the distal-limb, and computed tomography scan. RESULTS: Twenty-eight patients got good perfusion of the lower body after the surgery. Two patients received femoral-femoral artery bypass immediately after surgery because of the thrombosis in the right common iliac artery, without further injury. No peripheral vessels damage occurred, and no compartment fasciotomy or amputation needed. One patient died for the sepsis and the subsequent multi organ failure 28 days postoperative. CONCLUSIONS: The modified axllio-femoral perfusion could restore the lower limbs' perfusion simultaneously during the aortic surgery without neither delaying dissection repair nor prolonging the ischemic time. It is a simple, but safe and effective technique.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Artéria Axilar/cirurgia , Artéria Femoral/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Ponte Cardiopulmonar/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Espectroscopia de Luz Próxima ao Infravermelho , Adulto Jovem
6.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31791089

RESUMO

This study evaluated the morphological changes of the lower limb and associated hemodynamic responses to different lower-body compression pressures (COMPs) in physically active, healthy individuals at rest. Each of the 32 participants underwent three trials with three different degrees of lower-body compression applied: "Low" (2.2±1.4 mmHg), "Medium" (12.9±3.9 mmHg), and "High" (28.8±8.3 mmHg). In each COMP, a cross-sectional area of leg muscles (CSAmuscle), subcutaneous fat (CSAfat), superficial vessels (SupV), deep arteries (DA), and deep veins (DV) at the calf, knee, and thigh levels were measured using magnetic resonance imaging (MRI). Additionally, blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were measured using Doppler ultrasound (USCOM®). With High COMP, calf CSAmuscle and SupV were smaller (p<0.01), whereas DA and DV were larger (p<0.05). Calf CSAfat, however, was similar among all COMPs. There were no major changes in CSAmuscle and CSAfat at knee and thigh levels. CO (3.2±0.9 L/min) and SV (51.9±16.4 mL) were higher (p<0.05) only with High COMP, but other hemodynamic variables showed no significant changes across different COMPs. The High COMP at the lower limb induces leg morphological changes and increases associated hemodynamic responses of physically active healthy individuals at rest.


Assuntos
Hemodinâmica/fisiologia , Extremidade Inferior/fisiologia , Meias de Compressão , Artérias/diagnóstico por imagem , Artérias/fisiologia , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Volume Sistólico/fisiologia , Gordura Subcutânea/irrigação sanguínea , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiologia , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Veias/diagnóstico por imagem , Veias/fisiologia , Adulto Jovem
7.
World Neurosurg ; 133: 178-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606502

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) focally destroys abnormal or dysfunctional tissue using thermal energy generated from alternating current. The utilization of RFA has gained popularity as a minimally invasive procedure for the treatment of skeletal metastases with a particular focus on palliative pain treatments to the spine, pelvis, long bones, sternum, and glenoid. More recently, single-session procedures that combine RFA with vertebral augmentation techniques have allowed treatment to areas of pain associated with pathologic fractures secondary to metastatic disease. Although many studies have been done to investigate the safety and efficacy of RFA, there have been no reported cases to date in which the use of RFA for the treatment of spinal metastases has led to any major permanent neurological injury. CASE DESCRIPTION: This report describes a case of a 61-year-old woman who underwent RFA and kyphoplasty for spinal metastases and noted the immediate onset of lower extremity paralysis after the procedure. To the best of our knowledge, this is the first documented case of permanent lower extremity paralysis in the medical literature after radiofrequency thermal ablation of spine metastases. CONCLUSIONS: Postoperative magnetic resonance imaging and physical examination suggest RFA-induced thermal injury as the most likely mechanism of paralysis. In this report, a review of previous in vivo models used in studying the efficacy and safety of spine RFA is conducted. Additionally, the literature has been reviewed for any neurological events reported with the use of RFA in the treatment of patients with vertebral pathology.


Assuntos
Cifoplastia/efeitos adversos , Paraplegia/etiologia , Ablação por Radiofrequência/efeitos adversos , Neoplasias da Coluna Vertebral/cirurgia , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário
8.
Comput Methods Biomech Biomed Engin ; 23(3): 114-125, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31881812

RESUMO

Medical images are not typically included in protocol of motion laboratories. Thus, accurate scaling of musculoskeletal models from optoelectronic data are important for any biomechanical analysis. The aim of the current study was to identify a scaling method based on optoelectronic data, inspired from literature, which could offer the best trade-off between accurate geometrical parameters (segment lengths, orientation of joint axes, marker coordinates) and consistent inverse kinematics outputs (kinematic error, joint angles). The methods were applied on 26 subjects and assessed with medical imagery building EOS-based models, considered as a reference. The main contribution of this paper is to show that the marker-based scaling followed by an optimisation of orientation joint axes and markers local coordinates, gives the most consistent scaling and joint angles with EOS-based models. Thus, when a non-invasive mean with an optoelectronic system is considered, a marker-based scaling is preliminary needed to get accurate segment lengths and to optimise joint axes and marker local coordinates to reduce kinematic errors.AbbrevationsAJCAnkle joint centreCKEcumulative kinematic errorDoFdegree of freedomEBEOS-basedHBheight-basedHJChip joint centreKJCknee joint centreMBmarker-basedMSMmusculoskeletal modelsSPMstatistical parametric mappingSTAsoft tissue artifactEBa.m∗EOS-based with optimised joint axes, and all model markers coordinatesMBa.m∗marker-based with optimised joint axes, and all model markers coordinatesMBl.a.mmarker-based with optimised segment lengths, joint axes, and selected model markers coordinatesASISanterior superior illiac spinePSISposterior superior illiac spine.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Modelos Biológicos , Pontos de Referência Anatômicos , Fenômenos Biomecânicos , Feminino , Humanos , Articulações/fisiologia , Masculino , Rotação , Adulto Jovem
9.
Plast Reconstr Surg ; 145(1): 85-96, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881608

RESUMO

BACKGROUND: Current guidelines recommend individual risk stratification, chemoprophylaxis, and risk mitigation to prevent venous thromboembolism. However, the evidence for efficacy is lacking in plastic surgery outpatients. Anticoagulation can cause bleeding. Ultrasound technology offers a highly accurate screening method. METHODS: A prospective study was undertaken among 1000 consecutive cosmetic surgery outpatients who were scanned at three times: before surgery, the day after surgery, and 1 week after surgery (inclusion rate, 93 percent). Intravenous sedation was used, with no muscle relaxation. Compression, Doppler color flow, and waveform analysis were performed on the deep veins of the lower extremities, including the calves. Affected patients were followed with weekly scans. No chemoprophylaxis was ordered. Sequential compression devices were used during the first half of the study. RESULTS: Nine deep venous thromboses were detected (0.9 percent). Two thromboses were found on scans performed the day after surgery. Six thromboses were detected on the scan approximately 1 week after surgery. One deep venous thrombosis was detected 35 days after surgery. Eight of the nine patients were prescribed oral anticoagulants. All affected patients recovered fully. The mean time to thrombosis resolution was 4.8 weeks. A logistic regression found no deep venous thrombosis risk reduction from sequential compression devices. Patient age was significantly associated with deep venous thromboses (p < 0.05). CONCLUSIONS: Ultrasound surveillance offers an effective method for early detection and treatment of postoperative deep venous thromboses. This technology offers an alternative to risk stratification and chemoprophylaxis, which causes iatrogenic bleeding. Sequential compression devices are unnecessary for plastic surgery outpatients undergoing total intravenous anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Cirurgia Plástica/métodos , Ultrassonografia Doppler Dupla/métodos , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Trombose Venosa/prevenção & controle
10.
Radiol Med ; 125(4): 432-435, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31848805

RESUMO

AIM: Since the response to conservative and surgical treatments in lymphedema is based only on clinical evaluation, we want to propose a new technique for the volume calculation of lower extremities affected by lymphedema. MATERIALS AND METHODS: Ten female patients affected by primary LE of the lower limbs (mean age 33 ± 5 years; age range 16-42) underwent NCMRL in September 2019. Acquisition protocol included a STIR sequence (FOV 460 × 504 mm; matrix 315 × 384 pixel; voxel size 1.1 × 1.1 × 1.0 mm; TR 3000 ms; TE 254 ms; TI 160 ms). Two readers independently performed a manual segmentation with ITK-SNAP open-source software to assess the volume of the lower limbs. The agreement for volumetric segmentation between the two operators was assessed through intraclass correlation coefficient (ICC). RESULTS: Mean segmentation time was 5 ± 0.3 min. ICC demonstrated excellent intra-examiner agreements for both readers 1 (ICC = 0.9991, p < 0.0001) and 2 (ICC = 0.9989, p < 0.0001). Inter-reader agreement was excellent (ICC = 0.9991, p < 0.0001). CONCLUSIONS: Manual segmentation with ITK-SNAP of NCMRL examinations in patients affected by primary lower limb LE represents a reproducible procedure for an objective evaluation of volumes, useful for follow-up.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Adolescente , Adulto , Meios de Contraste , Feminino , Humanos , Linfografia , Imagem por Ressonância Magnética , Adulto Jovem
11.
BMC Med Imaging ; 19(1): 96, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847822

RESUMO

BACKGROUND: To explore the diagnostic performance of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) for the evaluation of venous pathology of the lower extremity. METHODS: This was a single-centre prospective cohort study of 25 patients with suspected venous disease in the lower extremities. Each patient received Doppler ultrasonography (for venous evaluation) before the scheduled TRANCE-MRI (for venous and arterial evaluations) on a 1.5 T MR scanner (Philips Ingenia, Philips Healthcare, Best, the Netherlands), followed by lymphography and computed tomography angiography that were arranged according to the diagnostic indications. RESULTS: The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9 and 88%, respectively. The inter-rater agreement for deep vein thrombosis (DVT) of the thigh between the ultrasonography and TRANCE-MRI results was substantial agreement (Cohen's kappa κ, 0.72). In ultrasonography-negative cases, TRANCE-MRI detected four additional cases (16%, 4/25) of DVT; three cases (12%, 3/25) of venous compression caused by pelvic lymphadenopathy, hip prosthesis or knee joint effusion; one case (4%, 1/25) of vena cava anomaly; two cases (8%, 2/25) of occult peripheral artery disease (PAD); and one case (4%, 1/25) of an occluded bypass graft. CONCLUSION: TRANCE-MRI can be used as an alternative and objective tool for assessing lower extremity diseases, especially suspected venous pathology. Compared with ultrasonography, TRANCE-MRI plays a better role in assessing varicose veins of the lower extremities and deep veins of the pelvis and abdomen. However, false-positive results may occur in the left common iliac vein of elderly patients. Finally, occult PAD rarely occurs in patients with suspected lower extremity venous disease. Therefore, we recommend performing the TRANCE-MRV protocol instead of the full protocol (MRV + MRA) in the clinical setting in patients with venous scenarios.


Assuntos
Extremidade Inferior/irrigação sanguínea , Angiografia por Ressonância Magnética/métodos , Trombose Venosa/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Linfografia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia Doppler
12.
PLoS One ; 14(12): e0226795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860687

RESUMO

OBJECTIVES: The aim of this study was to evaluate the morphological changes of the femur in the coronal plane in progressing varus gonarthrosis and to explore the interrelation of each component. PATIENTS AND METHODS: From January to July 2017, radiographic images of 1538 knees of 883 consecutive patients were collected and analyzed. We drew the alignments and measured the orientation angles of the lower extremities and compared the results among age groups for each sex. Correlation and regression tests were used to analyze the measurements. RESULTS: There were significant differences in the neck-shaft angle (NSA), femoral bowing angle (FBA) and anatomic medial distal femoral angle (aMDFA) by age group in females, whereas the differences were not significant in males. In females, a positive correlation was found between age and the FBA and aMDFA (r = 0.253, 0.141, p<0.01), and a negative correlation was found between age and the NSA while the FBA was controlled (r = -0.065, p<0.05). The FBA was positively correlated with the NSA (r = 0.312, p<0.01) and aMDFA (r = 0.233, p<0.01). The NSA, FBA, and aMDFA together affected 72.2% of the mechanical medial distal femoral angle (mMDFA) (ß = 0.071, -0.528, 0.803, p<0.01). CONCLUSION: As knee osteoarthritis (KOA) progressed, dynamic deformation of the femur was found in females, while no obvious changes were found in males. Femoral mechanical axis varus (mMDFA decrease) was the result of changes in the NSA, FBA and aMDFA. The deformation was throughout the femur rather than in a local area, as femur bowing can lead to corresponding changes in both ends of the femur. We provided a theoretical basis for TKA and knee-salvage treatment, and more attention should be paid to aging patients, especially females, in the preoperative protocol for orthomorphia.


Assuntos
Fêmur/diagnóstico por imagem , Fêmur/patologia , Osteoartrite do Joelho/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia , Radiografia , Estudos Retrospectivos , Terapia de Salvação , Fatores Sexuais , Adulto Jovem
13.
Acta Clin Croat ; 58(Suppl 1): 74-81, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741563

RESUMO

During the last two decades ultrasound guidance has been established as an invaluable tool for performing peripheral nerve blocks. Ultrasound guidance reduces block performance time, volume of local anesthetic, risk of intravascular injection and need for opioid rescue analgesia compared to landmark based and neurostimulator guided techniques. The use of ultrasound guidance must not be understood as a surrogate to, but should complement a thorough understanding of anatomy. The purpose of this overview is to present ultrasound guided techniques for performing basic lower extremity blocks, as well as to discuss more recent trends in providing regional analgesia for patients undergoing lower extremity surgery.


Assuntos
Analgesia/métodos , Anestesia por Condução/métodos , Extremidade Inferior/cirurgia , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção , Anestésicos Locais , Competência Clínica , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Procedimentos Ortopédicos , Manejo da Dor , Ferimentos e Lesões/cirurgia
14.
J Pediatr Orthop ; 39(10): 521-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599863

RESUMO

BACKGROUND: Biplanar radiography with 3-dimensional (3D) modeling (EOS) provides a comprehensive assessment of lower limb alignment in an upright weight-bearing position with less radiation than conventional radiography. A study was performed to assess the consistency and reliability of 2 lower extremity 3D biplanar radiograph models created at least 1 year apart in a pediatric population. METHODS: All patients who had 2 lower extremity radiographic evaluations with EOS performed at visits a minimum of 1 year apart were reviewed. Digital radiographs, of lower extremities in both frontal and sagittal planes, were acquired simultaneously, using the EOS system. The 3D reconstruction of the images was achieved utilizing the SterEOS software. Pelvic position, femoral and tibial anatomy, and the torsional profile were evaluated and compared using t tests. RESULTS: In total, 53 patients with a mean age of 11.7 years (range, 6.1 to 18.9 y) met inclusion criteria. When comparing 3D models between visits, minimal differences were noted in proximal femoral anatomy and pelvic alignment (pelvic incidence, sacral slope, sagittal tilt, neck shaft angle). Expected differences in femoral and tibial length corresponded with normal longitudinal growth between visits. Sagittal plane knee position varied widely between examinations. Femoral and/or tibial rotational osteotomies were performed in 37% of extremities between examinations. After femoral derotational osteotomy, a significant difference in femoral anteversion was appreciated when comparing preoperative and postoperative 3D models. However, this difference was less than the expected difference based on the anatomic correction achieved intraoperatively. No differences were noted in tibial torsion measures after tibial derotational osteotomy. CONCLUSIONS: The 3D modeling based on biplanar radiographs provides consistent and reliable measures of pelvic and hip joint anatomy of the lower extremity. Patient positioning may influence the reproducibility of knee alignment. The torsional profile assessment did not accurately reflect changes obtained by derotational osteotomy. LEVEL OF EVIDENCE: Level III.


Assuntos
Articulação do Quadril/diagnóstico por imagem , Imageamento Tridimensional/métodos , Extremidade Inferior/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Adolescente , Criança , Simulação por Computador , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Masculino , Osteotomia , Radiografia , Reprodutibilidade dos Testes , Rotação , Software , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Fatores de Tempo
15.
Cardiovasc Intervent Radiol ; 42(11): 1619-1626, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471721

RESUMO

PURPOSE: This study evaluates the image quality of lower extremity CT venography reconstructed with orthopedic metal artifact reduction (O-MAR) in patients with unilateral or bilateral metallic prostheses in the hip or knee. METHODS: This retrospective study was approved by our institutional review board, and informed consent was waived. Twenty-nine patients of lower extremity CT with 51 metallic hip or knee prostheses were reconstructed to both standard CT images and O-MAR images. The subjective image quality and vessel conspicuity for both images were evaluated by two readers using five-point scales (0-4). Vessel conspicuity scores of 3 or 4 were considered diagnostically acceptable. Image noise was measured in the air and subcutaneous fat. RESULTS: O-MAR images showed significantly higher scores of subjective image quality (p < .001) and vessel conspicuity (p = .002) than standard CT images. Diagnostic acceptance of vessel conspicuity was not significantly different between O-MAR images and standard CT images (p = 1.000). O-MAR images showed significantly less image noise than conventional CT images (p < .001 for both air and subcutaneous fat). CONCLUSION: O-MAR may be an effective solution for the metal artifacts in lower extremity CT venography; however, the distance between prostheses and vessels affects the diagnostic acceptance in patients with metallic hip or knee prostheses. LEVEL OF EVIDENCE: Level 4, Case Series.


Assuntos
Artefatos , Extremidade Inferior/diagnóstico por imagem , Flebografia/métodos , Próteses e Implantes , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
BMC Musculoskelet Disord ; 20(1): 366, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391039

RESUMO

BACKGROUND: During ambulatory follow-up of patients with cerebral palsy (CP) systematic radiographic screening is required firstly to evaluate hip migration and development in the prevention of hip dislocation and secondly to analyse lower limb alignment and leg length. The Migration Percentage (MP) is a radiographic measurement used to describe the extent of femoral head lateralisation on conventional supine pelvic radiographs. Our goal was to assess the comparability of the MP measured on low radiation dose EOS® standing full-leg radiographs with that of conventional supine pelvic radiographs. METHODS: Patients presenting with CP were prospectively selected from our outpatient follow-up consultation at our institutions CP reference centre and underwent conventional supine pelvic and EOS® standing full-leg radiographs the same day for diagnostic and screening reasons. RESULTS: Out of 28 prospectively selected patients we included 21 (42 hips), of which 10 were female, with a mean age of 9.25 years and GMFCS levels of I, II and III. Seven out of 28 patients were excluded due to insufficient quality of radiographic images. The absolute differences in MP measured on both conventional supine pelvic and EOS® standing full-leg radiographs ranged between - 8 and 6% with an absolute mean difference of 0% (SD ±3.5) and were not statistically significant (p = 0.99). A Bland-Altman plot showed acceptable agreement between both measurements without proportional bias. CONCLUSION: There is no statistical significant difference between the Migration Percentage measured on conventional supine pelvic radiographs and EOS® standing full-leg radiographs in ambulant patients. These images use lower radiation doses and contain more radiographic information. TRIAL REGISTRATION: Approved by the Medical Research Ethics committee of the University Hospitals Leuven ( MP001492 ).


Assuntos
Paralisia Cerebral/complicações , Luxação do Quadril/diagnóstico por imagem , Criança , Feminino , Seguimentos , Luxação do Quadril/etiologia , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Decúbito Dorsal
17.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31413181

RESUMO

Scurvy is a rare disease in developed nations. In the field of pediatrics, it primarily is seen in children with developmental and behavioral issues, malabsorptive processes, or diseases involving dysphagia. We present the case of an otherwise developmentally appropriate 4-year-old boy who developed scurvy after gradual self-restriction of his diet. He initially presented with a limp and a rash and was subsequently found to have anemia and hematuria. A serum vitamin C level was undetectable, and after review of the MRI of his lower extremities, the clinical findings supported a diagnosis of scurvy. Although scurvy is rare in developed nations, this diagnosis should be considered in a patient with the clinical constellation of lower-extremity pain or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and anemia. This case highlights the importance of carefully assessing a child's dietary and developmental status at well-child visits, which can help avoid a more invasive workup.


Assuntos
Dieta/efeitos adversos , Escorbuto/etiologia , Anemia Ferropriva/etiologia , Ácido Ascórbico/sangue , Pré-Escolar , Exantema/etiologia , Hematúria/etiologia , Humanos , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Escorbuto/diagnóstico por imagem , Deficiência de Vitamina D/etiologia
18.
J Am Acad Orthop Surg ; 27(17): 659-666, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31442211

RESUMO

BACKGROUND: Interplay between degenerative hip and spine conditions (Hip-Spine Syndrome [HiSS]) warrants effective communication between respective surgeons. We identified radiographic parameters to distinguish a subset of patients with HiSS by evaluating hip osteoarthritis (HOA) in patients with and without spinopelvic malalignment, categorizing patients into respective HiSS types, and comparing radiographic parameters. METHODS: All patients with full-body orthogonal radiography from 2013 to 2016 were reviewed (n = 1,389). Using sagittal/coronal hip radiographs, HOA (Kellgren-Lawrence Grade) was noted, and pelvic incidence-lumbar lordosis mismatch (PI-LL) > 10° was considered spinal malalignment. Patients groups included non-HiSS (PI-LL ≤ 10°/Grade 0/n = 444), Hip (PI-LL ≤ 10°/Grade 3-4/n = 78), Spine (PI-LL > 10°/Grade 0/n = 297), or Hip-Spine (PI-LL > 10°/Grade 3-4/n = 30). Parameters were compared using ANOVA with post-hoc Bonferroni analysis. RESULTS: HiSS Hip type patients had less hip extension capability compared with non-HiSS, Spine, and Hip-Spine type patients, reflected by lowest pelvic tilt (PT)/sagittal retroversion (11.3° versus 16.5°/29.2°/25.2°, respectively) and less hip extension per sacrofemoral angle (10.1° versus 19.5°/28.4°/23.1°, respectively) (P < 0.001), as well as 4.7° increase in anterior tilt/sagittal anteversion compared with age-matched individuals. Hip-Spine type patients had less pelvic retroversion than Spine type patients (P = 0.045); these differences were greater when referenced to age-matched individuals (P < 0.001). Hip-Spine type patients had less hip extension than Spine type patients (P = 0.013). Hip type patients had greater knee flexion than non-HiSS type patients (6.4° versus 2.6°; P < 0.001). Moreover, Hip-Spine type patients had comparable lower extremity alignment compared with Spine type patients, except for greater posterior pelvic shift. CONCLUSION: Our novel HiSS categorization used established classification methods and supported PT use to potentially improve the ability to discern HiSS types/pathologies in a subset of patients with HOA and spinal sagittal malalignment. HOA grade 3 to 4 with PT <15° are categorized as Hip type and those with PT >25° are Hip-Spine type with sagittal malalignment, which may impact acetabular arthroplasty component placement.


Assuntos
Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/fisiopatologia , Radiografia , Idoso , Estudos de Coortes , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Imagem Corporal Total
19.
IEEE Int Conf Rehabil Robot ; 2019: 71-76, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374609

RESUMO

Control of lower-limb assistive devices would benefit from predicting the intent of individuals in advance of upcoming motion, rather than estimating the current states of their motion. Human lower-limb motion estimation using ultrasound (US) image derived features of skeletal muscle has been demonstrated. However, predictability of motion in time remains an open question. The objective of this study was to assess the predictability of distal lower-limb motion using US image features of rectus femoris (RF) muscle during non-weight-bearing knee flexion/extension. A series of time shifts was introduced between the US features and the joint position in 67 ms steps from 0 ms (i.e., estimation, no prediction) up to predicting 467 ms in advance. A US-based algorithm to estimate lower-limb motion was then used to predict the knee joint position in time using the US features after introducing the time shifts. The accuracy of joint motion prediction after each time shift was compared to the accuracy of joint motion estimation. The reliability of the prediction was then assessed using an analysis of variance (ANOVA) test. The motion prediction accuracy was found to be reliable up to 200 ms, where the average root mean square error (RMSE) of prediction across 9 healthy subjects was 0.89 degrees greater than the average RMSE (7.39 degrees) of motion estimation for the same group of subjects. These findings suggest a reliable prediction of upcoming lower-limb motion is feasible using the US features of skeletal muscle up to a certain point. A reliable prediction may provide lower-limb assistive device control systems with a time-window for processing and control planning, and actuation hence improving the volitional control behaviors of lower-limb assistive devices.


Assuntos
Extremidade Inferior/fisiologia , Músculo Esquelético/diagnóstico por imagem , Adolescente , Adulto , Algoritmos , Feminino , Voluntários Saudáveis , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Músculo Esquelético/fisiologia , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Ultrassonografia , Adulto Jovem
20.
J Knee Surg ; 32(10): 1033-1038, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31434142

RESUMO

Mechanically aligned total knee arthroplasty (MATKA) aims to make alignment of the hip, knee, and ankle straight unexceptionally. However, emerging evidence suggests that unexceptional straightening the mechanical axis of the lower limb may lead to clinical and radiological problems of the ankle joint. By contrast, kinematically aligned total knee arthroplasty (KATKA) strives to restore the articular surface of the prearthritic knee. In this study, we examined results from KATKA and MATKA to determine which surgery restores the ankle joint orientation closer to the native ankle joint in bipedal stance and hypothesized that KATKA, rather than MATKA, would be more effective. Data from long-leg standing radiographs of 60 healthy adults (control group, n = 120 knees), patients who underwent MATKA (n = 90 knees), and patients who underwent KATKA (n = 90 knees) were retrospectively reviewed. The hip-knee-ankle angle, orientation of the tibial plafond and the talar dome relative to the ground (G-plafond and G-talus, respectively), and orientation of the plafond relative to the mechanical axis of the limb (M-plafond and M-talus, respectively) were measured and analyzed for comparison. Results show that bipedal stance alignment in patients who underwent KATKA (G-plafond: -0.65 ± 3.03 and G-talus: -1.72 ± 4.02) were not significantly different to native ankle joint alignment indicated by the control group. Compared with the native ankle joint measured in the control group (G-plafond: -0.76 ± 2.69 and G-talus: -1.30 ± 3.25), the tibial plafond and talar dome significantly tilted laterally relative to the ground in ankle joints after MATKA (G-plafond: -2.32 ± 3.30 and G-talus: -2.97 ± 3.98, p = 0.001 and p = 0.004, respectively). Thus, postoperative ankle joint line orientation after KATKA was horizontal to the floor and closer to that of native ankle joints than those after MATKA. The level of evidence is Level III.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Artroplastia do Joelho/métodos , Mau Alinhamento Ósseo/prevenção & controle , Articulação do Joelho/cirurgia , Extremidade Inferior/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Adulto , Idoso , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/etiologia , Mau Alinhamento Ósseo/cirurgia , Feminino , Genu Varum/diagnóstico por imagem , Genu Varum/etiologia , Genu Varum/fisiopatologia , Genu Varum/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Prótese do Joelho , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Posição Ortostática , Adulto Jovem
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