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2.
Ann Afr Med ; 19(1): 8-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32174609

RESUMO

Background: Deep-venous thrombosis (DVT) of lower limbs is one of the most common causes of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. B-mode and color Doppler imaging are needed for the early diagnosis of DVT to prevent complications and sequalae of DVT. Objectives: The objectives of this study are to evaluate the role of Doppler ultrasound in diagnosing DVT of lower limbs and to study the spectrum of findings in patients with DVT in Zaria. Methodology: A retrospective study was carried out on patients who had Venous Doppler Scan in the Department of Radiology ABUTH, Zaria, Nigeria, for suspected DVT over a period of 4 years from February 2014 to January 2018. Scans were done using DC-3 and DC-6 Mindray Ultrasound machines (2009 and 2013 Models, respectively, Shantou, China) coupled with high-frequency (7.5-12 MHz) linear and low-frequency curvilinear (2-5 MHz) transducers. Analysis of cases of DVT was performed in terms of age, sex, clinical features, predisposing conditions, anatomic distribution, stage, and pattern of thrombus involvement in the veins. Data were analyzed using the SPSS version 20.0 and value of P < 0.005 was considered as statistically significant. Results: A total of 252 patients' results were reviewed which consisted of 122 males (48.4%) and 130 females (51.6%). The patients' ages ranged from 11 to 80 years, averaging 45.5 ± 9.56 years. The most common indication for Doppler request was leg swellings. The most common risk factor for DVT was malignancy (36%), cardiac disorders (18%), and traumas (14%). Sixty-six (61%) cases showed left-sided and 26 (24%) right-sided, whereas 16 (15%) cases showed bilateral lower limb involvement. Predominant thrombus was above-knee region with 54% in the superficial femoral vein. Chronic stage was seen in 46 (42%) cases, subacute in 44 (41%) cases, and acute in 18 (17%) cases. Conclusion: Middle-aged females, left-sided leg, and above-knee segment were predominantly affected with DVT; hence, this buttresses the need for Doppler ultrasound in the diagnosis of DVT in all patients.


Assuntos
Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Trombose Venosa/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Radiol Med ; 125(5): 474-480, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32166719

RESUMO

PURPOSE: The purpose of this study was to evaluate the change in capillary blood volume in the muscles of the lower limbs, before and after exercise, using intravoxel incoherent motion (IVIM). MATERIALS AND METHODS: Diffusion-weighted images were obtained (with 16 b values) from the thigh and leg muscles of 11 subjects. The imaging was obtained before and immediately exercise; additionally, imaging was performed at 3 h, 6 h, and 24 h after exercise, and an IVIM index was calculated. The exercise involved walking up and down a flight of stairs (140 steps) ten times. The IVIM of each time course-before and after the exercise-was compared. In addition, we examined the correlation of IVIM measurements with the degree of the muscle ache that occurred at 24 h following the exercise. RESULTS: The IVIM index significantly increased after exercise compared with that before exercise (P < 0.01). IVIM decreased at 3 h following exercise, but increased again at 24 h. A correlation was found between the IVIM index at 24 h after exercise and the degree of the muscle ache (r = 0.80) CONCLUSIONS: The capillary blood volume significantly increased after exercise when compared to before exercise. The capillary blood volume decreased after exercise at 3 h and 6 h following exercise, but it increased again at 24 h. There was a correlation between the degree of muscle ache and the amount of capillary blood volume measured from the femoral muscle at 24 h after exercise.


Assuntos
Volume Sanguíneo , Capilares/fisiologia , Extremidade Inferior/irrigação sanguínea , Músculo Esquelético/irrigação sanguínea , Subida de Escada/fisiologia , Adulto , Capilares/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Mialgia/fisiopatologia , Estudos Prospectivos , Coxa da Perna/irrigação sanguínea , Coxa da Perna/diagnóstico por imagem , Fatores de Tempo , Adulto Jovem
5.
Medicine (Baltimore) ; 99(5): e18952, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000418

RESUMO

RATIONALE: Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue neoplasm with controversial histogenesis. ASPS accounts for 0.5% to 1% of all soft tissue sarcomas. Because of its rarity, ASPS is easily misdiagnosed, increasing the risk of incorrect treatment. PATIENT CONCERNS: A 6-year-old female patient presented with a history of a 2.0 × 2.5 × 3.0-cm mass in the deep soft tissues of her right lower extremity. DIAGNOSES: Histopathological features indicated the diagnosis of ASPS. Microscopically, a diffuse arrangement of tumor cells or pseudoalveolar architectures separated by thin and well-vascularized fibrous septa were observed. Immunohistochemical staining of the tumor cells indicated positivity for transcription factor E3, myogenic determination factor 1, and periodic acid-Schiff-diastase (PAS-D) and showed a Ki-67 proliferating index of approximately 20%. INTERVENTIONS: The patient underwent enlarged resection of the tumor and was treated with radiotherapy. OUTCOMES: During the 3-year follow-up, the patient has remained in good condition, with no symptom recurrence, distant metastatic spread, or significant toxicity during or after treatment. The patient remains under regular surveillance. LESSONS: Its low incidence, lack of characteristic clinical manifestations, and atypical location often lead to ASPS misdiagnosis and subsequent incorrect treatment. Nuclear expression of transcription factor E3 is of diagnostic value for ASPS. At present, there is no consensus on the treatment for ASPS. In-depth pathological analysis is needed to better understand the characteristics of this tumor.


Assuntos
Sarcoma Alveolar de Partes Moles/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/patologia , Sarcoma Alveolar de Partes Moles/patologia , Sarcoma Alveolar de Partes Moles/radioterapia , Sarcoma Alveolar de Partes Moles/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia
7.
Angiology ; 71(2): 122-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31303025

RESUMO

The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.


Assuntos
Espessura Intima-Media Carotídea , Isquemia/complicações , Isquemia/diagnóstico por imagem , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Trombose/complicações , Trombose/diagnóstico por imagem , Fatores Etários , Idoso , Estado Terminal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
8.
Phys Ther ; 100(2): 317-323, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-31588510

RESUMO

BACKGROUND AND PURPOSE: Contracture and toe-walking in children due to vascular anomaly of the calf musculature is rarely described, and there is limited evidence regarding treatment. The purpose of this case is to describe the novel use of serial casting, combining the knee and ankle, to reduce contracture in a child with hemangioma of the calf. CASE DESCRIPTION: An 11-year-old girl received 12 casts of the ankle and knee, followed by custom orthotics, to address chronic contracture and gait impairments caused by a vascular anomaly in the posterior compartment of the lower extremity. OUTCOMES: After casting, the patient had fully restored knee range of motion and improved ankle range of motion by 45 degrees. She received custom orthotics and maintained her range of motion 4 months after casting. DISCUSSION: Serial casting of the knee and ankle may be a useful alternative to surgical lengthenings in patients with chronic contractures caused by vascular anomalies of the lower extremity.


Assuntos
Tornozelo , Moldes Cirúrgicos , Contratura/terapia , Hemangioma/complicações , Joelho , Perna (Membro)/irrigação sanguínea , Criança , Contratura/etiologia , Pé Equino/etiologia , Pé Equino/terapia , Feminino , Hemangioma/diagnóstico por imagem , Humanos , Perna (Membro)/diagnóstico por imagem , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/terapia , Recidiva Local de Neoplasia/complicações , Aparelhos Ortopédicos , Fotografação , Amplitude de Movimento Articular
9.
J Surg Oncol ; 121(1): 51-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31612513

RESUMO

BACKGROUND: The current standard to locate lymphatic vessels for lymphovenous anastomosis (LVA) is the use of indocyanine green (ICG)-lymphangiography. Due to fluid retention and fibrosis of tissue in patients with lymphedema, often present in Caucasian patients, vessels deeper than 0.5 cm below the dermis cannot be visualized. We present our experiences with ultrasound in locating deeper lymphatic vessels in lower extremities. MATERIALS AND METHODS: In total, 28 patients with lymphedema and positive lymphoscintigraphy were included. With ultrasound, we located 82 lymphatic vessels in lower extremities preoperatively without the use of ICG marking. Vessel diameter, depth, and exact location were examined. Using a coordinate system, a mapping of the detected lymphatic vessels was created. The ultrasound findings were confirmed under microscope and ICG intraoperatively. RESULTS: In all, we detected 28 Caucasian patients and 82 lymphatic vessels with ultrasound preoperatively. On average, we found three lymphatic vessels (range, 2-6) at each patient. Of the ultrasound-detected lymphatic vessels, 90.2% could be verified intraoperatively under a microscope. Before skin incision, lymphatic vessels could be visualized in 40% of our patients with ICG. In the mapping of the lymphatic vessels, we found no significant pattern. CONCLUSION: Ultrasound can precisely detect lymphatic vessels for efficient LVA operation without the prior use of ICG-lymphangiography.


Assuntos
Anastomose Cirúrgica/métodos , Vasos Linfáticos/diagnóstico por imagem , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Linfocintigrafia , Masculino , Ultrassonografia/métodos
10.
J Surg Oncol ; 121(1): 75-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31273800

RESUMO

BACKGROUND: Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. METHODS: Between 2012 and 2018, 44 primary lower-extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single-photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra-abdominal side-to-end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. RESULTS: Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower-extremity lymphedema. All CVBs remained patent, though one required re-anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. CONCLUSIONS: Evaluating primary lower-extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra-abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.


Assuntos
Linfonodos/transplante , Linfangioma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Linfangioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
11.
Plast Reconstr Surg ; 145(1): 164e-171e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881626

RESUMO

BACKGROUND: Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes. METHODS: Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection. RESULTS: Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation. CONCLUSIONS: Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Rejeição de Enxerto/prevenção & controle , Traumatismos da Perna/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Insuficiência Venosa/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Incidência , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Ultrassonografia Doppler Dupla , Veias/diagnóstico por imagem , Insuficiência Venosa/complicações , Insuficiência Venosa/epidemiologia , Trombose Venosa/complicações , Trombose Venosa/epidemiologia , Adulto Jovem
13.
BMC Musculoskelet Disord ; 20(1): 564, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31766997

RESUMO

BACKGROUNDS: Though malalignment of lower legs is a common pathologic phenomenon in multiple hereditary exostoses (MHE), relationship between locations of exostoses and malalignment of lower legs remains unclear. This study examined radiographs of MHE patients in an attempt to evaluate the tendency of coronal malalignment of lower legs with different location of exostoses on lower legs consisting of two parallel long bones. METHODS: Between 2000 and 2017, we retrospectively reviewed the anteroposterior films of the teleo-roentgenographics of 63 patients with MHE. The patients were classified into four different groups depending on the locations of the exostosis, which occurred on both proximal and distal tibiofibular joints (A), proximal tibiofibular joint (B), distal tibiofibular joint (C), and not for the tibiofibular joint area (D). To evaluate the influence of the location of exostoses on coronal malalignment of lower legs, medial proximal tibia angle (MPTA), lateral distal tibia angle (LDTA), and fibular shortening were analyzed for each group. RESULTS: Significant difference was observed in multiple comparative analyses for each of the four groups. On MPTA radiologic analysis, group A showed greatest value with significant difference compared with groups C and D (vs. (B): p = 0.215; vs. distal joints (C): p = 0.004; vs. (D): p = 0.001). Group B showed significant difference only with group D (vs. distal joints (C): p = 0.388; vs. (D): p = 0.002), but for group C and D showed no significant difference. For LDTA, only group A showed significant difference compared to other groups (p < 0.001). With regard to tibiofibular ratio for evaluation of fibular shortening, group A showed the lowest ratio (vs. (B): p = 0.004; vs. (C): p = 0.655; vs. (D): p < 0.001). Group C also presented the significant lower ratio than group D (p = 0.002). CONCLUSIONS: For evaluation of the coronal malalignment of lower legs in MHE patients, not only ankle around the distal tibiofibular joint but also proximal tibiofibular joint should be examined, in that, lower limb deformity occurred by two parallel long bone which has self-contained joint. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Exostose Múltipla Hereditária/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Exostose Múltipla Hereditária/complicações , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
14.
Br J Radiol ; 92(1104): 20190221, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31596118

RESUMO

OBJECTIVE: Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative vs more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration. METHODS: 26 asymptomatic volunteers underwent T2* mapping. The tendon was divided axially into seven subregions. Summary statistics for T2* within each subregion were calculated and compared using Tukey post-hoc pairwise comparisons. RESULTS: Results are reported for 24 subjects. The mean tibialis posterior tendon T2* was 7 ± 1 ms. Subregion values ranged from 6 ± 1 to 9 ± 2 ms with significant between-region differences in T2*. Inter- and intrarater absolute agreement intraclass correlation coefficient (ICC) values were all "excellent" (0.75 < ICC=1.00) except for regions 5 through 7, which had "fair to good" interrater and/or and intrarater ICC values (0.4 < ICC=0.75). CONCLUSION: A tibialis posterior tendon T2* mapping protocol, subregion division method, and baseline T2* values for clinically relevant regions were established. Significant differences in T2* were observed along the tendon length. ADVANCES IN KNOWLEDGE: This work demonstrates that regional variation exists and should be considered for future T2*-based research on posterior tibias tendon degeneration and when using T2* mapping to evaluate for potential tibialis posterior tendon degeneration.


Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tendões/diagnóstico por imagem , Adulto , Pontos de Referência Anatômicos/anatomia & histologia , Doenças Assintomáticas , Feminino , Humanos , Perna (Membro)/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ossos do Tarso/anatomia & histologia , Ossos do Tarso/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Tendinopatia/patologia , Tendões/anatomia & histologia , Adulto Jovem
15.
J Radiol Case Rep ; 13(4): 38-45, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31565180

RESUMO

Angiomatoid fibrous histiocytoma is a rarely metastasizing soft-tissue tumor of low-grade malignancy. Here we report a case of angiomatoid fibrous histiocytoma located in the leg of a 15-year-old female. This case is of particular interest due to its radiological features that led to raise two questions concerning the nature of the disease (is it reactive or tumoral?) and its site of origin (within soft tissues or the tibial periosteum?). Here we describe ultrasound, magnetic resonance imaging, computed tomography scan and positron emission tomography findings that helped answer these questions, understand the real nature of the disease and its appropriate treatment. This case shows that a single type of imaging technique may not be sufficient to understand the real nature of a musculoskeletal lesion and that it is necessary to combine all information derived from various imaging techniques in order to correctly diagnose and treat the disease.


Assuntos
Histiocitoma Fibroso Maligno/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Feminino , Histiocitoma Fibroso Benigno/diagnóstico por imagem , Histiocitoma Fibroso Maligno/patologia , Humanos , Perna (Membro)/patologia , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Neoplasias de Tecidos Moles/patologia , Tomografia Computadorizada por Raios X , Ultrassonografia
16.
PLoS Negl Trop Dis ; 13(10): e0007762, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584959

RESUMO

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (LF) emphasizes hygiene, exercise, and other measures to reduce morbidity and disability related to LF. We recently reported that a portable, three-dimensional, infrared imaging system (3DIS) provides accurate limb volume measurements in patients with filarial lymphedema. To assess the practical utility of repeated 3DIS measurements for longitudinal lymphedema management, we examined intraday and day-to-day leg volume changes in adults with filarial lymphedema in southern Sri Lanka. METHODOLOGY AND PRINCIPAL FINDINGS: We assessed 41 participants with lower extremity lymphedema (stages 1-6) in their homes in the mornings (6:00-9:00 AM) and afternoons (2:00-6:00 PM) of three days within one calendar week. Two examiners performed replicate 3DIS volume measurements at each visit. Median coefficient of variation among replicate volume measurements was 1.7% (IQR 1.1% - 2.3%) for left legs and 2.2% (IQR 1.6% - 2.8%) for right legs. Median intraday volume increase was 3.0%. Range among daily volume measurements tended to be lower for afternoon measurements (median 2.25%, IQR 1.4%- 5.4%) than for morning measurements (median 3.0%, IQR 1.4% - 8.4%). CONCLUSIONS AND SIGNIFICANCE: Limb volume measurements by 3DIS are accurate and reproducible, and this technique is feasible for use in patients' homes. We have developed practical suggestions for optimal outcomes with 3DIS. Duplicate measurements should be performed and repeat assessments should be done at approximately the same time of day to minimize bias. Duplicate measures that vary by more than 8% should prompt review of scanning technique with a repeat measurement. With proper training and attention to technique, 3DIS can be a valuable tool for healthcare workers who work with lymphedema patients.


Assuntos
Filariose Linfática/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Imageamento Tridimensional/métodos , Raios Infravermelhos , Adulto , Idoso , Extremidades/patologia , Feminino , Pessoal de Saúde/educação , Humanos , Perna (Membro)/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sri Lanka
17.
Heart Surg Forum ; 22(4): E289-E293, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398094

RESUMO

Phlegmasia cerulea dolens is an acute fulminating form of extensive venous thrombosis. Limb loss, post-thrombotic syndrome and life-threatening conditions can occur without appropriate management. Treatment methods vary; there presently is no consensus on the best form of treatment. Endovascular procedures have been a good option for treating deep vein thrombosis, yet they may be insufficient for patients suffering from phlegmasia cerulea dolens. Venous thrombectomy with the guidance of venography quickly relieves symptoms, hardly causes complications, yields optimal mid-term results, and can be a justifiable treatment for phlegmasia cerulea dolens.


Assuntos
Perna (Membro)/irrigação sanguínea , Trombectomia/métodos , Trombose Venosa/cirurgia , Angioplastia com Balão/métodos , Embolectomia com Balão/instrumentação , Embolectomia com Balão/métodos , Evolução Fatal , Feminino , Veia Femoral , Humanos , Veia Ilíaca/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Poplítea , Trombectomia/instrumentação , Trombose Venosa/diagnóstico por imagem
18.
Clin Rheumatol ; 38(12): 3549-3556, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31463825

RESUMO

OBJECTIVES: This study aimed to evaluate the relationship of leg muscle symmetry to the prevalence, radiographic grade, and symptoms of knee osteoarthritis (OA). METHOD: We conducted a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey (KNHANES), collected in 2010 and 2011. Men and women aged 60 years or older were included. Leg muscle mass was measured using dual-energy X-ray absorptiometry, and the muscle asymmetry index was defined as ∣(left leg muscle mass)/(left and right leg muscle mass) × 100 - 50∣. Statistical analyses were performed to examine the relationships between the muscle asymmetry index and the radiographic grade and knee symptoms. RESULTS: A total of 2548 subjects were included in the analysis. The muscle asymmetry index was positively associated with radiographic knee OA grade and knee pain, especially in men. Men with knee OA and the highest quartile of muscle asymmetry index were 3.3 times more likely to have knee pain compared with those in the lowest quartile. When subjects were divided into four groups by body mass index (BMI) and muscle asymmetry index, subjects with asymmetric obese and men with asymmetric normal BMI had worse grade of radiographic knee OA. CONCLUSIONS: Leg muscle asymmetry in men, irrespective of obesity, was associated with significantly higher grade of radiographic knee OA and prevalent knee pain. Longitudinal studies will be needed to determine the cause-and-effect relationship and to determine whether the higher or lower mass, beyond the asymmetry, is associated with radiographic severity or symptomatic knee OA.Key Points•Leg muscle asymmetry was related to prevalence and radiographic severity of knee OA, especially in men.•Leg muscle asymmetry was associated with knee pain.•Those with both leg muscle asymmetry and obesity showed higher prevalence of knee pain and worse radiographic knee OA.


Assuntos
Articulação do Joelho/patologia , Perna (Membro)/patologia , Músculo Esquelético/patologia , Obesidade/complicações , Osteoartrite do Joelho/patologia , Idoso , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Masculino , Músculo Esquelético/diagnóstico por imagem , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , República da Coreia/epidemiologia
20.
Medicina (Kaunas) ; 55(9)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466356

RESUMO

Calcific myonecrosis is a rare disease that has been shown to be a late sequela of trauma. This article presents a 68-year-old man with calcific myonecrosis of the leg 40 years after a tibial fracture complicated with peroneal nerve palsy. The soft tissue mass increased in size after another injury to the leg that occurred two years before his presentation. Physical examination at presentation showed a palpable extra-osseous mass at the anterior aspect of the left leg; the mass was not adherent to adjacent soft-tissues and bone, and it was painless but tender to palpation. Radiographs of the left leg showed extensive calcification at the soft-tissue of the anterior and posterior leg. An ultrasonography-guided trocar biopsy was done; histological findings were indicative of calcific myonecrosis. Given the benign entity of the lesion and known high rate of complications, he was recommended for no further treatment except for clinical and imaging observation. Located at the site of the biopsy, he experienced infection with drainage that eventually healed after six months with antibiotics and wound dressing changes. During the last follow-up examination, two years after diagnosis, the patient was asymptomatic without progression of the mass.


Assuntos
Calcinose , Músculo Esquelético/patologia , Doenças Musculares , Idoso , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/patologia , Humanos , Perna (Membro)/diagnóstico por imagem , Masculino , Músculo Esquelético/diagnóstico por imagem , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/etiologia , Doenças Musculares/patologia , Necrose , Fraturas da Tíbia/complicações
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