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1.
BMC Anesthesiol ; 21(1): 64, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653264

RESUMO

BACKGROUND: Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. METHOD: We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. RESULTS: Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. CONCLUSION: The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.


Assuntos
/complicações , Debilidade Muscular/etiologia , Idoso , Braço/fisiopatologia , Estudos Transversais , Feminino , Seguimentos , França , Humanos , Perna (Membro)/fisiopatologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(11): e23576, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725923

RESUMO

ABSTRACT: Short-term immobilization leads to fatty muscular degeneration, which is associated with various negative health effects. Based on literature showing very high correlations between MRI Dixon fat fraction and Speed-of-Sound (SoS), we hypothesized that we can detect short-term-immobilization-induced differences in SoS.Both calves of 10 patients with a calf cast on one side for a mean duration of 41 ±â€Š26 days were examined in relaxed position using a standard ultrasound machine. Calf perimeters were measured for both sides. A flat Plexiglas-reflector, placed vertically on the opposite side of the probe with the calf in-between, was used as a timing reference for SoS. SoS was both manually annotated by two readers and assessed by an automatic annotation algorithm. The thickness values of the subcutaneous fat and muscle layers were manually read from the B-mode images. Differences between the cast and non-cast calves were calculated with a paired t test. Correlation analysis of SoS and calf perimeter was performed using Pearson's correlation coefficient.Paired t test showed significant differences between the cast and non-cast side for both SoS (P < .01) and leg perimeter (P < .001). SoS was reduced with the number of days after cast installment (r = -0.553, P = .097). No significant differences were found for muscle layer thickness, subcutaneous fat layer thickness, mean fat echo intensity, or mean muscle echo intensity.Short-term-immobilization led to a significant reduction in SoS in the cast calf compared to the healthy calf, indicating a potential role of SoS as a biomarker in detecting immobilization-induced fatty muscular degeneration not visible on B-mode ultrasound.


Assuntos
Traumatismos da Perna/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Restrição Física/efeitos adversos , Ultrassonografia/métodos , Adulto , Idoso , Moldes Cirúrgicos/efeitos adversos , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/fisiopatologia , Traumatismos da Perna/fisiopatologia , Traumatismos da Perna/terapia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Atrofia Muscular/etiologia , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Som , Adulto Jovem
4.
Muscle Nerve ; 63(4): 553-562, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33462896

RESUMO

BACKGROUND: Quantitative muscle MRI as a sensitive marker of early muscle pathology and disease progression in adult-onset myotonic dystrophy type 1. The utility of muscle MRI as a marker of muscle pathology and disease progression in adult-onset myotonic dystrophy type 1 (DM1) was evaluated. METHODS: This prospective, longitudinal study included 67 observations from 36 DM1 patients (50% female), and 92 observations from 49 healthy adults (49% female). Lower-leg 3T magnetic resonance imaging (MRI) scans were acquired. Volume and fat fraction (FF) were estimated using a three-point Dixon method, and T2-relaxometry was determined using a multi-echo spin-echo sequence. Muscles were segmented automatically. Mixed linear models were conducted to determine group differences across muscles and image modality, accounting for age, sex, and repeated observations. Differences in rate of change in volume, T2-relaxometry, and FF were also determined with mixed linear regression that included a group by elapsed time interaction. RESULTS: Compared with healthy adults, DM1 patients exhibited reduced volume of the tibialis anterior, soleus, and gastrocnemius (GAS) (all, P < .05). T2-relaxometry and FF were increased across all calf muscles in DM1 compared to controls. (all, P < .01). Signs of muscle pathology, including reduced volume, and increased T2-relaxometry and FF were already noted in DM1 patients who did not exhibit clinical motor symptoms of DM1. As a group, DM1 patients exhibited a more rapid change than did controls in tibialis posterior volume (P = .05) and GAS T2-relaxometry (P = .03) and FF (P = .06). CONCLUSIONS: Muscle MRI renders sensitive, early markers of muscle pathology and disease progression in DM1. T2 relaxometry may be particularly sensitive to early muscle changes related to DM1.


Assuntos
Perna (Membro)/patologia , Imagem por Ressonância Magnética , Músculo Esquelético/patologia , Distrofia Miotônica/patologia , Adolescente , Adulto , Idoso , Biomarcadores/análise , Feminino , Humanos , Perna (Membro)/fisiopatologia , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/fisiopatologia , Estudos Prospectivos , Adulto Jovem
5.
Medicine (Baltimore) ; 99(32): e21608, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769918

RESUMO

BACKGROUND: Venous leg ulcers (VLUs) are common throughout the world, which seriously affects the patient's work and life. Relevant researches suggested that sclerosing foam (SF) has potential benefits for VLUs. However, there is no consistent conclusion. The purpose of our study is to assess whether SF is effective and safe for VLUs. METHODS: Relevant clinical randomized controlled trials will be obtained from a search of 8 databases (with no language restrictions) from their inception to May 2020: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, and Chinese Biological Medicine. Data will be analyzed using RevMan 5.3 after literature screening and data extraction according to predefined inclusion and exclusion criteria. Cochrane Collaboration Risk of bias Tool will be applied in evaluating the quality of enrolled articles. The primary outcome is Closure of venous leg ulcers, ulcer healing rate, adverse events related to SF. The secondary outcomes include ulcer healing time, ulcer recurrence rate, pain. Risk ratio will be used for categorical data; mean differences will be used for measurement data. Where possible and appropriate, meta-analysis will be performed for each outcome. RESULTS: To clarify whether Sclerosing foam can be safe and efficient on treating venous leg ulcers. CONCLUSION: Our review will provide useful information to judge whether Sclerosing Foam is an effective and safe intervention for patients with venous leg ulcers.


Assuntos
Bandagens/normas , Protocolos Clínicos , Células Espumosas , Soluções Esclerosantes/uso terapêutico , Úlcera Varicosa/terapia , Humanos , Perna (Membro)/anormalidades , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Metanálise como Assunto , Soluções Esclerosantes/normas , Revisões Sistemáticas como Assunto
6.
Expert Rev Med Devices ; 17(8): 785-794, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32658589

RESUMO

INTRODUCTION: Heart failure is associated with increased neurohormonal activation that results in changes in body composition including volume overload and the loss of skeletal muscle, body fat, and bone density. Bioelectrical impedance measures body composition based on the conduction of electrical current through body fluids. AREAS COVERED: The PubMed and Scopus databases were reviewed up to the third week of June 2020. Cross-sectional studies, retrospective observational studies, prospective observational studies, and randomized controlled trials have examined numerous bioelectrical impedance monitoring strategies to guide the diagnosis, prognosis, and treatment of heart failure. These monitoring strategies include intrathoracic impedance, lung impedance, bioelectrical impedance vector analysis, leg bioelectrical impedance, and thoracic bioreactance. EXPERT COMMENTARY: Based on the current evidence, more studies are needed to validate bioelectrical impedance in heart failure. Lung impedance appears to be useful for guiding heart failure treatment in patients with ST-elevation myocardial infarction and improving outcomes in outpatients with heart failure. Furthermore, bioelectrical impedance has potential as a noninvasive, quantitative heart failure variable for population-based research.


Assuntos
Impedância Elétrica , Insuficiência Cardíaca/fisiopatologia , Composição Corporal/fisiologia , Insuficiência Cardíaca/diagnóstico , Humanos , Perna (Membro)/fisiopatologia , Monitorização Fisiológica , Prognóstico
8.
Medicine (Baltimore) ; 99(16): e19814, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312000

RESUMO

RATIONALE: Behçet Disease (BD) is a chronic inflammatory vasculitis with thrombogenicity and multisystem involvement. Deep vein thrombosis (DVT) in the lower extremities is the most frequent manifestation of vascular involvement in BD. The causes of thrombosis vary widely and include congenital predisposition and acquired factors, but of all the thrombosis, the cause is rarely BD. Furthermore, there are few reports of treatment for thrombosis in BD. PATIENT CONCERNS: We herein describe the case of an Asian male patient aged 40 years, admitted to our hospital for left leg pain, edema, and swelling. DIAGNOSES: We confirmed the DVT and pulmonary artery thrombosis (PAT) by contrast computed tomography angiogram. At the same time, the patient developed oral ulcerations and skin lesions consistent with BD. INTERVENTIONS: The patient was initially treated with anticoagulants. However, because the improvement of DVT was inadequate, we added colchicine in anticipation of anti-inflammatory effects. After that, anticoagulation was discontinued, and only colchicine was continuously prescribed. OUTCOMES: We observed an almost complete resolution of DVT and PAT with no recurrence of thrombosis for 6 months after discharge. LESSONS: This case shows us that we should consider BD as a differential diagnosis of DVT and that colchicine therapy is effective for inflammation-induced thrombosis in BD.


Assuntos
Síndrome de Behçet/complicações , Colchicina/uso terapêutico , Moduladores de Tubulina/uso terapêutico , Trombose Venosa/tratamento farmacológico , Adulto , Anticoagulantes/uso terapêutico , Grupo com Ancestrais do Continente Asiático/etnologia , Síndrome de Behçet/patologia , Colchicina/administração & dosagem , Angiografia por Tomografia Computadorizada/métodos , Quimioterapia Combinada , Edema/diagnóstico , Edema/etiologia , Humanos , Perna (Membro)/fisiopatologia , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Dor/diagnóstico , Dor/etiologia , Artéria Pulmonar/patologia , Trombose/tratamento farmacológico , Resultado do Tratamento , Moduladores de Tubulina/administração & dosagem , Trombose Venosa/etiologia
9.
Am J Phys Med Rehabil ; 99(10): 895-901, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32251109

RESUMO

OBJECTIVE: The aim of the study was to investigate differences between flail limb syndrome and amyotrophic lateral sclerosis. DESIGN: A retrospective chart review identified 16 cases of amyotrophic lateral sclerosis and 16 of flail limb syndrome. Revised Amyotrophic Lateral Sclerosis Functional Rating Scale, compound muscle action potential amsplitudes, and rate of loss of vital capacity were compared. RESULTS: Comparing amyotrophic lateral sclerosis and flail limb syndrome patients, rate of loss of vital capacity was 5.26% ± 0.33% versus 0.54% ± 0.06%, respectively (P < 0.05). No patient in the flail limb syndrome group had a rate of loss of vital capacity more than 0.65% per month. No patient in the amyotrophic lateral sclerosis group had a rate of loss of vital capacity less than 4.6% per month. The average ulnar nerve compound muscle action potential amplitudes were significantly lower in flail limb syndrome (P < 0.05). No significant difference was observed in the rate of Revised Amyotrophic Lateral Sclerosis Functional Rating Scale decline or average peroneal, tibial, and median nerve compound muscle action potential amplitudes. CONCLUSIONS: In flail limb syndrome, an average monthly decrease in vital capacity exceeding 0.65% may suggest a spread of motor neuron loss to higher cervical anterior horn areas and raise the possibility of progression to amyotrophic lateral sclerosis. Larger prospective studies are needed to investigate the rate of VC decline in flail limb syndrome and limb-onset amyotrophic lateral sclerosis and to establish whether a cutoff score combining rate of loss of vital capacity and compound muscle action potential amplitude mainly of the ulnar nerve might predict progression of flail limb syndrome to amyotrophic lateral sclerosis, the knowledge of which can facilitate appropriate patient counseling.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Esclerose Amiotrófica Lateral/fisiopatologia , Braço/fisiopatologia , Perna (Membro)/fisiopatologia , Diagnóstico Diferencial , Progressão da Doença , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Capacidade Vital
10.
Neurology ; 94(15): e1622-e1633, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32184340

RESUMO

OBJECTIVE: To quantify disease progression in individuals with Duchenne muscular dystrophy (DMD) using magnetic resonance biomarkers of leg muscles. METHODS: MRI and magnetic resonance spectroscopy (MRS) biomarkers were acquired from 104 participants with DMD and 51 healthy controls using a prospective observational study design with patients with DMD followed up yearly for up to 6 years. Fat fractions (FFs) in vastus lateralis and soleus muscles were determined with 1H MRS. MRI quantitative T2 (qT2) values were measured for 3 muscles of the upper leg and 5 muscles of the lower leg. Longitudinal changes in biomarkers were modeled with a cumulative distribution function using a nonlinear mixed-effects approach. RESULTS: MRS FF and MRI qT2 increased with DMD disease duration, with the progression time constants differing markedly between individuals and across muscles. The average age at half-maximal muscle involvement (µ) occurred 4.8 years earlier in vastus lateralis than soleus, and these measures were strongly associated with loss-of-ambulation age. Corticosteroid treatment was found to delay µ by 2.5 years on average across muscles, although there were marked differences between muscles with more slowly progressing muscles showing larger delay. CONCLUSIONS: MRS FF and MRI qT2 provide sensitive noninvasive measures of DMD progression. Modeling changes in these biomarkers across multiple muscles can be used to detect and monitor the therapeutic effects of corticosteroids on disease progression and to provide prognostic information on functional outcomes. This modeling approach provides a method to transform these MRI biomarkers into well-understood metrics, allowing concise summaries of DMD disease progression at individual and population levels. CLINICALTRIALSGOV IDENTIFIER: NCT01484678.


Assuntos
Biomarcadores/análise , Perna (Membro)/fisiopatologia , Músculo Esquelético/patologia , Distrofia Muscular de Duchenne/fisiopatologia , Adolescente , Corticosteroides/metabolismo , Corticosteroides/farmacologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Perna (Membro)/patologia , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiopatologia , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/tratamento farmacológico , Caminhada/fisiologia
11.
J Wound Ostomy Continence Nurs ; 47(2): 173-181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150141

RESUMO

PURPOSE: The purpose of this study was to investigate the use of an mHealth application (app), self-management physical activity intervention FOOTFIT with an added patient-provider connectivity feature (FOOTFIT+), that was designed to strengthen the lower extremities of minimally ambulatory individuals with venous leg ulcers (VLUs). DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: Twenty-four adults 18 years and older with VLUs being treated in 2 wound clinics in the Southeastern United States participated in this study. METHODS: Preliminary estimates and 95% confidence intervals for the medians of short-term functional impacts on foot function, strength, ankle range of motion, walking capacity, depression, and physical functioning were obtained pre- and postassessment after the 6-week intervention trial. RESULTS: There were negligible changes in either group for foot function. It is noted that both groups experienced substantial foot and ankle impairment at baseline. The greatest improvement in range of motion was noted in the FOOTFIT group for dorsiflexion of the right ankle (4.6 ± 5.22 lb/in over baseline) whereas strength decreased in both ankles for dorsiflexion and plantar flexion in the FOOTFIT+ group. No improvements were noted in walking distance or physical health for FOOTFIT (slight decrease -2.9 ± 5.6) and FOOTFIT+ (slight increase 3.0 ± 6.6) during the 6-week study period. CONCLUSIONS: In a minimally ambulatory population with VLUs, our mHealth FOOTFIT intervention composed of progressive exercise "boosts" demonstrated minimal short-term effects. We recommend engagement with the app for a longer period to determine longer-term outcomes of lower extremity function.


Assuntos
Exercício Físico/psicologia , Perna (Membro)/irrigação sanguínea , Telemedicina/instrumentação , Úlcera Varicosa/terapia , Idoso , Feminino , Humanos , Perna (Membro)/anormalidades , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sudeste dos Estados Unidos , Telemedicina/métodos , Úlcera Varicosa/fisiopatologia
13.
Gait Posture ; 77: 89-94, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32004951

RESUMO

BACKGROUND: Reduced push-off intensity during walking is thought to play an important role in age-related mobility impairment. We posit that an age-related shift toward shorter plantarflexor operating lengths during walking functionally limits force generation, and thereby the ability of those muscles to respond to increased propulsive demands during walking. RESEARCH QUESTION: To determine whether gastrocnemius muscle fascicle lengths during normal walking: (1) are shorter in older than young adults, and (2) correlate with one's capacity to increase the propulsive demands of walking to their maximum. METHODS: We used in vivo cine B-mode ultrasound to measure gastrocnemius fascicle lengths in 9 older and 9 young adults walking at their preferred speed, their maximum speed, and with horizontal impeding forces that increased in a ramped design at 1%BW/s to their maximum. A repeated measures ANOVA tested for effects of age and walking condition, and Pearson correlations assessed the relation between fascicle outcomes and condition performance. RESULTS: A tendency toward shorter medial gastrocnemius muscle fascicle lengths in older versus young adults was not statistically significant. However, older adults walked with reduced peak fascicle shortening during all conditions compared to young adults - an outcome not explained by reduced muscle-tendon unit shortening and exacerbated during tasks with greater than normal propulsive demand. As hypothesized, we found a strong and significant positive correlation in older subjects between gastrocnemius fascicle lengths during normal walking and performance on the ramped impeding force condition (p = 0.005, r²â€¯= 0.704), even after controlling for isometric strength (p = 0.011, r²â€¯= 0.792) and subject stature (p = 0.010, r²â€¯= 0.700). SIGNIFICANCE: Our findings provide muscle-level insight to develop more effective rehabilitation techniques to improve push-off intensity in older adults and assistive technologies designed to steer plantarflexor muscle fascicle operating behavior during functional tasks.


Assuntos
Marcha/fisiologia , Perna (Membro)/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Perna (Membro)/fisiologia , Perna (Membro)/fisiopatologia , Masculino , Músculo Esquelético/fisiologia , Músculo Esquelético/fisiopatologia , Equipamentos de Autoajuda , Tendões/fisiologia , Ultrassonografia , Caminhada/fisiologia , Adulto Jovem
14.
Sci Rep ; 10(1): 1615, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005856

RESUMO

The neural substrates related to periodic leg movements during sleep (PLMS) remain uncertain, and the specific brain regions involved in PLMS have not been evaluated. We investigated the brain regions associated with PLMS and their severity using the electroencephalographic (EEG) source localization method. Polysomnographic data, including electromyographic, electrocardiographic, and 19-channel EEG signals, of 15 patients with restless legs syndrome were analyzed. We first identified the source locations of delta-band (2-4 Hz) spectral power prior to the onset of PLMS using a standardized low-resolution brain electromagnetic tomography method. Next, correlation analysis was conducted between current densities and PLMS index. Delta power initially and most prominently increased before leg movement (LM) onset in the PLMS series. Sources of delta power at -4~-3 seconds were located in the right pericentral, bilateral dorsolateral prefrontal, and cingulate regions. PLMS index was correlated with current densities at the right inferior parietal, temporoparietal junction, and middle frontal regions. In conclusion, our results suggest that the brain regions activated before periodic LM onset or associated with their severity are the large-scale motor network and provide insight into the cortical contribution of PLMS pathomechanism.


Assuntos
Encéfalo/fisiopatologia , Perna (Membro)/fisiopatologia , Movimento/fisiologia , Síndrome das Pernas Inquietas/fisiopatologia , Fases do Sono/fisiologia , Sono/fisiologia , Adulto , Idoso , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Estudos Retrospectivos , Adulto Jovem
15.
Sci Rep ; 10(1): 1473, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32001783

RESUMO

This study aimed to investigate the acute effect of whole-body vibration (WBV) on the reflex and non-reflex components of spastic hypertonia and intramuscular blood perfusion among individuals with chronic stroke. Thirty-six people with chronic stroke (age: 61.4 ± 6.9 years) participated in this randomized controlled cross-over study. Each participant underwent two testing conditions: static standing for 5 minutes with WBV (30 Hz, 1.5 mm) or no-vibration. We assessed the soleus H-reflex, shear modulus (ultrasound elastography) and vascular index (color power Doppler ultrasound) of the medial gastrocnemius (MG) muscle on either paretic or non-paretic side at baseline and every 1-min post-intervention up to 5 minutes. The results revealed a significant inhibition of the H/M ratio bilaterally for the WBV condition (absolute change on paretic side: 0.61 ± 0.35, p = 0.001; non-paretic side: 0.34 ± 0.23, p = 0.001), but not the control condition. The inhibition of H-reflex was sustained up to 4 minutes and 3 minutes on the paretic and non-paretic side, respectively. The vascular index of MG muscle was significantly increased only for the WBV condition [paretic: from 0.55 ± 0.07 to 1.08 ± 0.18 (p = 0.001); non-paretic: from 0.82 ± 0.09 to 1.01 ± 0.13 (p < 0.001)], which lasted for 3 minutes and 5 minutes, respectively. No significant change of the shear modulus in the MG muscle was observed, regardless of the testing condition. Based on our results, WBV had an acute effect on modulating spastic hypertonia dominated by hyperreflexia in people with chronic stroke and facilitating greater intramuscular blood perfusion. No acute effect on passive muscle stiffness was observed.


Assuntos
Circulação Sanguínea/fisiologia , Reflexo H , Perna (Membro)/irrigação sanguínea , Hipertonia Muscular/etiologia , Acidente Vascular Cerebral/complicações , Vibração/uso terapêutico , Doença Crônica , Estudos Cross-Over , Feminino , Humanos , Perna (Membro)/fisiopatologia , Masculino , Hipertonia Muscular/terapia , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos
16.
BMJ Case Rep ; 13(1)2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31924707

RESUMO

A 49-year-old man presented to the hospital for spinal cord decompression surgery with left buttock and left leg pain. The patient described an acute burning pain radiating down from his left buttock to left lateral leg. He also noted a 13.6 kg weight loss in recent months. Physical examination showed decreased muscle bulk of the left thigh, decreased strength of the left hip, left knee flexors and extensors. Recent MRI spine showed mild canal narrowing and cord flattening in the lower thoracic spine. Serologic testing showed an elevated glucose of 17.9 mmol/L and haemoglobin A1c of 9.8%. Electromyography showed denervation of scattered muscles of the left knee flexors, hip flexors and adductors. In the setting of newly diagnosed diabetes mellitus, he was diagnosed with diabetic amyotrophy, started on insulin therapy, and his surgery was cancelled.


Assuntos
Dor nas Costas/etiologia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/tratamento farmacológico , Insulina Glargina/uso terapêutico , Diagnóstico Diferencial , Eletromiografia , Humanos , Hipoglicemiantes/uso terapêutico , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade
17.
Clin Neurophysiol ; 131(1): 167-176, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794958

RESUMO

OBJECTIVE: Essential tremor (ET) prominently affects the upper-limbs during voluntary movements, but can also affect the lower-limbs, head, and chin. Although deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of thalamus improves both clinical ratings and quantitative measures of tremor, no study has quantified effects of DBS on tremor across multiple body parts. Our objective was to quantify therapeutic effects of DBS across multiple body parts in ET. METHODS: We performed quantitative assessment of tremor in ET patients who had DBS for at least one year. We assessed tremor on and off VIM-stimulation using triaxial accelerometers on the upper-limbs, lower-limbs, head and chin during seated and standing tasks. RESULTS: VIM-DBS significantly reduced tremor, but there was no statistical difference in degree of tremor reduction across the measured effectors. Compared to healthy controls, ET patients treated with DBS showed significantly greater tremor power (4-8 Hz) across all effectors during seated and standing tasks. CONCLUSIONS: VIM-DBS reduced tremor in ET patients. There was no significant difference in the degree of tremor reduction across the measured effectors. SIGNIFICANCE: This study provides new quantitative evidence that VIM-DBS is effective at reducing tremor across multiple parts of the body.


Assuntos
Estimulação Encefálica Profunda/métodos , Tremor Essencial/terapia , Núcleos Ventrais do Tálamo/fisiologia , Aceleração , Acelerometria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Queixo/fisiopatologia , Tremor Essencial/fisiopatologia , Feminino , Mãos/fisiopatologia , Cabeça/fisiopatologia , Humanos , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade , Postura Sentada , Posição Ortostática
18.
Angiology ; 71(3): 208-216, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31387360

RESUMO

Transcutaneous oxygen tension measurement (TcPO2) is widely applied for the evaluation of chronic limb-threatening ischemia (CLTI). Nevertheless, studies that focused on the clinical value of TcPO2 have shown varying results. We identified factors that potentially play a role in TcPO2 measurement variation such as probe placement, probe temperature, and the use of a reference probe. In this review of the current literature, we assessed the application of these factors. A systematic search was conducted. Parameters that were assessed were probe placement, probe temperature, and mentioning and/or use of a reference probe. In total, 36 articles were eligible for analysis. In 24 (67%) studies, probes were placed on specific anatomical locations. Seven (19%) studies placed probes, regardless of the location of the ulcer, adjacent to an ischemic lesion or ulcer (perilesion). Selected temperature setting of the probe differed; in 18 (50%), a default probe temperature of 44°C was selected, and in 13 (36%), a different temperature was selected. In 31 (84%) studies, the use of a reference probe was not reported. Transcutaneous oxygen tension measurement is applied diversely in patients with CLTI. Homogeneity in TcPO2 protocols is warranted for reliable clinical application and to compare future TcPO2 research.


Assuntos
Isquemia/metabolismo , Perna (Membro)/fisiopatologia , Oxigênio/metabolismo , Doenças Vasculares Periféricas/metabolismo , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Doença Crônica , Humanos , Isquemia/fisiopatologia , Doença Arterial Periférica/metabolismo , Doença Arterial Periférica/fisiopatologia , Doenças Vasculares Periféricas/fisiopatologia , Temperatura
19.
Internist (Berl) ; 61(1): 36-43, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31848646

RESUMO

Swelling of soft parts of the lower extremities, whether uni- or bilateral, is a common reason for consulting a general practitioner (GP). Complex interactions mean that GPs are faced with a wide range of differential diagnoses during clarification of such findings. Of enormous importance is the prevention of a dangerous course, e.g., by initiating weight-adapted calculated antibiotic treatment, antithrombotic therapy, or even initial inpatient treatment and acute diagnostic workup in case of impending compartment syndrome or extensive venous thrombosis of the leg with or without suspicion of pulmonary embolism. Sometimes an acute venous thrombosis of the leg unmasks malignant disease. A swollen leg/swollen legs are frequently a leading symptom of decompensating heart or renal failure. Another possible cause are drug side effects, which may be exacerbated in a warm environment. An endocrine cause must also be considered in some cases. The GP is the appropriate physician for patients to contact and to initiate and coordinate diagnostics and treatment. In addition to coordination of specialist examinations, it is not infrequent that nurses and physiotherapists have to be involved in treatment, to ensure successful outpatient care.


Assuntos
Edema/diagnóstico , Medicina Geral , Perna (Membro)/fisiopatologia , Embolia Pulmonar/complicações , Insuficiência Venosa/complicações , Trombose Venosa , Diagnóstico Diferencial , Edema/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Extremidade Inferior
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