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1.
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
3.
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
4.
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
5.
Emerg Med J ; 36(7): 415-422, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31320334

RESUMO

CLINICAL INTRODUCTION: An 88-year-old woman presented with acute onset of involuntary limb movements for one day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109/68 mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15, and there was no evidence of Kernig's or Brudzinski's sign. She underwent a hip X-ray and non-contrast CT scan (figures 1 and 2).emermed;36/7/415/F1F1F1Figure 1Anteroposterior X-radiograph of the hip.emermed;36/7/415/F2F2F2Figure 2A non-contrast brain CT. QUESTION: What is the most likely cause of the clinical presentation?Acute meningitisCerebral fat embolismHaemorrhagic strokeHypertensive encephalopathy For answer see page 2 For question see page 1.


Assuntos
Embolia Gordurosa/complicações , Embolia Intracraniana/complicações , Perna (Membro)/anormalidades , Transtornos dos Movimentos/etiologia , Idoso de 80 Anos ou mais , Embolia Gordurosa/epidemiologia , Feminino , Humanos , Embolia Intracraniana/epidemiologia , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/fisiopatologia , Imagem por Ressonância Magnética/métodos , Transtornos dos Movimentos/epidemiologia , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos
6.
Hautarzt ; 70(9): 707-714, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31165190

RESUMO

BACKGROUND: The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations. MATERIAL AND METHODS: Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers. RESULTS: The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients. CONCLUSION: Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.


Assuntos
Bandagens Compressivas , Edema/terapia , Meias de Compressão , Úlcera Varicosa/prevenção & controle , Insuficiência Venosa/terapia , Humanos , Perna (Membro)/fisiopatologia , Pressão , Posição Ortostática
7.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(3): 188-191, 2019 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-31184076

RESUMO

Stroke has the characteristics of high prevalence, high morbidity, and high mortality, which seriously affects life quality of patients and also creates a huge social burden. Telerehabilitation technology is on the basis of traditional rehabilitation equipment and it integrates with cloud computing and big data technologies. It provides a new way for rehabilitation by providing comprehensive rehabilitation technology and service based on the cloud platform. Therefore, it provides a solution for the situation that the rehabilitation medical resources and the rehabilitation talents in China are relatively insufficient. This article mainly discusses the telerehabilitation technologies of lower extremity motor dysfunction in patients with stroke, the problems and the future development direction.


Assuntos
Perna (Membro) , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Telerreabilitação , China , Humanos , Perna (Membro)/fisiopatologia , Telerreabilitação/instrumentação
9.
Rev Sci Instrum ; 90(4): 043113, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31043035

RESUMO

In order to develop a low-cost wearable electromyography (EMG) sensor system that can be used at home, compacting the data size is studied first to extract potential features via frequency analysis. A low-cost wearable home-use EMG sensor is then developed. Results show the frequency band at 40-60 Hz of tibialis anterior offers significant differences to identify walking problems (p-value < 0.05), which can be used as a detection standard with a smaller data size. More significantly, data sizes are dramatically reduced by 95.06% compared to the original data size. This finding suggests a potential examining method for identifying pathological gait with the compacted data in satisfactory processing time that can be used at home.


Assuntos
Eletromiografia/instrumentação , Análise da Marcha/instrumentação , Autocuidado/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Diagnóstico por Computador , Eletromiografia/economia , Desenho de Equipamento , Análise da Marcha/métodos , Humanos , Perna (Membro)/fisiopatologia , Músculo Esquelético/fisiopatologia , Paraplegia/diagnóstico , Paraplegia/fisiopatologia , Autocuidado/economia , Processamento de Sinais Assistido por Computador , Dispositivos Eletrônicos Vestíveis/economia , Tecnologia sem Fio/economia , Tecnologia sem Fio/instrumentação
10.
Foot Ankle Int ; 40(7): 859-865, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30966780

RESUMO

Chronic exertional compartment syndrome (CECS) of the leg is a debilitating condition that has previously been characterized in athletes and military personnel. The results of surgical management in these patient populations have previously been published with inconsistencies in surgical methods and patient outcomes noted. While endoscopic and minimally invasive techniques have been described, a detailed description of a "standard" open, 2-incision lateral and single-incision medial technique for the treatment of CECS has not been previously published. The purpose of this technique article is to highlight several tips and considerations related to this procedure in the hopes of standardizing treatment and potentially improving patient outcomes. Level of Evidence: Level V, expert opinion.


Assuntos
Síndromes Compartimentais/cirurgia , Fasciotomia/métodos , Perna (Membro)/cirurgia , Doença Crônica , Exercício Físico , Humanos , Perna (Membro)/fisiopatologia
11.
J Rehabil Med ; 51(6): 426-433, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-30951177

RESUMO

OBJECTIVE: To determine whether there are differences in arm, leg and trunk activity measured by acceleration between weekdays and weekends in people undergoing rehabilitation in the subacute stage after stroke. DESIGN: Cross-sectional study. PATIENTS: Twenty-eight individuals with stroke (mean age 55.4 years; severe to mild impairment) and 10 healthy controls. METHODS: A set of 5 3-axial accelerometers were used on the trunk, wrists and ankles during 2 48-h sessions at weekdays and over a weekend. Day-time acceleration raw data were expressed as the signal magnitude area. Asymmetry between the affected and less-affected limb was calculated as a ratio. RESULTS: Participants with stroke used their both arms and legs less at weekends than on weekdays (p< 0.05, effect size 0.32-0.57). Asymmetry between the affected and less-affected arm was greater at weekends (p < 0.05, effect size 0.32). All activity measures, apart from the less-affected arm on weekdays, were lower in stroke compared with controls (p < 0.05, effect size 0.4-0.8). No statistically significant differences were detected between weekday and weekend activity for the control group. One-third of participants perceived the trunk sensor as inconvenient to wear. CONCLUSION: Increased focus needs to be applied on activities carried out during weekends at rehabilitation wards.


Assuntos
Acelerometria/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Idoso , Braço/fisiopatologia , Estudos Transversais , Feminino , Humanos , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tronco/fisiopatologia
12.
Wounds ; 31(5 Suppl): S29-S44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31033453

RESUMO

As the population ages and more people live with diabetes, obesity, and vascular disease, chronic wounds have become more prevalent. Increasingly, wound care falls into the hands of clinicians who may be new to the specialty. To facilitate a better understanding of wounds and to ensure all integral items for best outcomes are considered, an interprofessional panel of wound care experts developed a checklist to aid in lower extremity wound identification, assessment, evaluation, and potential complication recognition. This checklist focuses on an evidence-based approach to obtaining a medical history, evaluating the wound, determining the etiology, and assessing perfusion, edema, infection, and neurologic status. The goal of this fundamental evaluation tool is to help the clinician move towards the next steps in optimizing patient care. Evidence-based support for each item on the checklist is reviewed and detailed for clinician reference.


Assuntos
Lista de Checagem , Pé Diabético/diagnóstico , Úlcera da Perna/diagnóstico , Perna (Membro)/patologia , Obesidade/complicações , Doença Crônica , Pé Diabético/patologia , Pé Diabético/terapia , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Úlcera da Perna/patologia , Úlcera da Perna/terapia , Obesidade/patologia , Obesidade/fisiopatologia
13.
Chiropr Man Therap ; 27: 19, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31015956

RESUMO

Background: Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods: This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who 'often' treated patients with LBRLP compared to those who treated LBRLP 'never/rarely/sometimes'. Multiple logistic regression models identified independent factors associated with chiropractors who 'often' treated patients with LBRLP. Results: A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them 'often' treating LBRLP. Chiropractors who 'often' treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who 'often' treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions: Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.


Assuntos
Quiroprática/organização & administração , Dor Lombar/terapia , Manejo da Dor , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Perna (Membro)/fisiopatologia , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Inquéritos e Questionários , Adulto Jovem
14.
J Tissue Viability ; 28(2): 115-119, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824264

RESUMO

BACKGROUND: Venous leg ulceration is common in older adults in the United Kingdom. The gold-standard treatment is compression therapy. There are several compression bandage and hosiery systems that can be prescribed or purchased, but it was unclear what types of compression systems are currently being used to treat venous leg ulceration within the UK. This online scoping survey of registered nurses sought to (1) to identify what compression systems are available across the UK, (2) how frequently these are in use and (3) if there are any restrictions on their use. RESULTS: The results showed that registered nurses who treat patients with venous leg ulceration use a wide range of compression systems. The most frequently used systems are the 'less bulky' two-layer elastic and inelastic compression bandaging systems whilst two-layer hosiery was used less frequently and four-layer bandaging used infrequently. Nurses report that certain compression systems are less accessible through the usual procurement routes but this appears to be related to concerns about competency in application techniques. CONCLUSIONS: The data in this survey provides some important insights into the issues around the use of compression therapy for venous leg ulceration in the UK. Limiting access to certain types of compression may promote patient safety but limit patient choice. There may be underuse of the types of compression that promote patient independence, such as hosiery, and over-use of potentially sub-therapeutic therapy such as 'reduced compression'. Overall, this study suggests that further consideration is needed about the provision of compression therapy to UK patients with venous leg ulceration to optimise care and patient choice.


Assuntos
Bandagens Compressivas/normas , Enfermeiras e Enfermeiros/psicologia , Úlcera Varicosa/terapia , Estudos de Coortes , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Enfermeiras e Enfermeiros/tendências , Estudos Retrospectivos , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido , Úlcera Varicosa/prevenção & controle , Cicatrização/fisiologia
15.
Gynecol Oncol ; 153(2): 399-404, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30879878

RESUMO

OBJECTIVE: The primary aim of this study was to pilot the use of an objective measurement technique to prospectively evaluate the incidence of lower extremity lymphedema (LEL) after minimally invasive staging surgery for endometrial cancer. Secondary objectives included observation of changes in lower extremity function and quality of life in this patient population. METHODS: A prospective evaluation of LEL was performed in 97 women who underwent minimally invasive staging surgery for endometrial cancer using comparative circumferential volume measurements. Postoperative changes in lower extremity function and global quality of life were also assessed using patient-reported outcome measures. RESULTS: Ninety-seven patients were included for lymphedema analysis. The rate of LEL was 25% at 4-6 weeks, 19% at 6-9 months, and 27% at 12-18 months postoperatively. The presence of LEL was associated with a significant worsening from baseline Lower Extremity Functional Scale (LEFS) scores at 4-6 weeks (-27.0% vs -3.7%, p = 0.02) and 6-9 months (-13.0% vs 0%, p = 0.01). LEL was not associated with a change in patient-reported global quality of life. CONCLUSIONS: Up to one in four women experience lymphedema following surgical staging for endometrial cancer, and its presence is associated with diminished lower extremity function. Larger, prospective trials using the objective methodology piloted in this study should better clarify risk factors and long-term outcomes of this morbidity.


Assuntos
Neoplasias do Endométrio/cirurgia , Perna (Membro)/fisiopatologia , Linfedema/etnologia , Linfedema/fisiopatologia , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Linfedema/etiologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Estadiamento de Neoplasias , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida
17.
Dtsch Med Wochenschr ; 144(6): 398-410, 2019 03.
Artigo em Alemão | MEDLINE | ID: mdl-30870871

RESUMO

In case of an acute leg swelling a deep leg vein thrombosis needs to be excluded. In order to do this, compression sonography and the D-dimer-test are applied in the framework of an established diagnostic algorithm. The ensuing therapy consists in anticoagulation and compression.In case of a chronic leg swelling anamnesis and a clinical check-up often lead to a differential diagnosis. Chronic venous insufficiency is a generic term for a disturbed venous backflow. It is caused by an obstruction or an antegrade or retrograde flow insufficiency. Most common diseases in this context are varicosis or a post-thrombotic syndrome. Sonography and special function tests provide a diagnosis. The basic therapy consists in regular exercise, normalization of weight and compression therapy. In case of a hemodynamically relevant varicose vein surgery or endovascular treatment is advisable. The post-thrombotic syndrome must be treated consistently with the basic therapy.A lymphedema may be hereditary or acquired. In a first step diseases like neoplasia need to be excluded. The initial therapy consists in manual lymph drainage in combination with special compression bandages. Flat knit stockings should be prescribed. Surgical treatment is reserved for special circumstances.A lipedema is clinically diagnosed. It is characterized by lipohypertrophia, pressure sensitivity of the tissue and susceptibility to hematomas. Treatment options include weight reduction, regular exercise, lymph drainage and compression therapy, in some cases liposuction.


Assuntos
Edema , Perna (Membro) , Linfedema , Doenças Vasculares , Diagnóstico Diferencial , Edema/diagnóstico , Edema/etiologia , Edema/patologia , Edema/fisiopatologia , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/patologia , Perna (Membro)/fisiopatologia , Linfedema/complicações , Linfedema/diagnóstico , Linfedema/patologia , Linfedema/fisiopatologia , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/patologia , Doenças Vasculares/fisiopatologia
18.
World J Emerg Surg ; 14: 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30740139

RESUMO

Background: Early diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS. Methods: A model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA). Results: TFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8-4.0, p < 0.001). Conclusions: We found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now.


Assuntos
Síndromes Compartimentais/classificação , Ultrassonografia/normas , Pesos e Medidas/instrumentação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/fisiopatologia , Masculino , Ultrassonografia/métodos , Pesos e Medidas/normas
19.
Injury ; 50(3): 627-632, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30745127

RESUMO

INTRODUCTION: Acute compartment syndrome (ACS) is a limb-threatening condition often associated with leg injury. The only treatment of ACS is fasciotomy with the purpose of reducing muscle compartment pressures (MCP). Patient discomfort and low reliability of invasive MCP measurements, has led to the search for alternative methods. Our goal was to test the feasibility of using ultrasound to diagnose elevated MCP. METHODS: A cadaver model of elevated MCPs was used in 6 cadaver legs. An ultrasound transducer was combined with a pressure sensing transducer to obtain a B-mode image of the anterior compartment, while controlling the amount of pressure applied to the skin. MCP was increased from 0 to 75 mmHg. The width of the anterior compartment (CW) and the pressure needed to flatten the bulging superficial compartment fascia (CFFP) were measured. RESULTS: Both the CW and CFFP showed high correlations to MCP in the individual cadavers. Average CW and CFFP significantly increased between baseline and the first elevated MCP states. Both Inter-observer and intra-observer agreements for the ultrasound measurements were good to excellent. DISCUSSION: Ultrasound indexes showed excellent correlations in compartment pressures, suggesting that there is a potential for the clinical use of this modality in the future.


Assuntos
Síndrome do Compartimento Anterior/diagnóstico por imagem , Traumatismos da Perna/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Síndrome do Compartimento Anterior/patologia , Cadáver , Fasciotomia , Estudos de Viabilidade , Feminino , Humanos , Perna (Membro)/fisiopatologia , Traumatismos da Perna/patologia , Masculino , Músculo Esquelético/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes
20.
PLoS One ; 14(2): e0211895, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30716132

RESUMO

OBJECTIVE: Physical quality of life is reduced in ANCA-associated vasculitis (AAV). This study aims to investigate whether this may be explained by reduced muscle strength and physical activity resulting from disease damage and steroid myopathy. METHODS: Forty-eight AAV patients were sequentially included from the outpatient clinic. Patients in different stages of disease and treatment underwent measurements of muscle strength and anthropometric parameters. Patients filled in physical activity (Baecke) and quality of life questionnaires (RAND-36) and carried an accelerometer for a week. Muscle strength and physical activity were compared to quality of life, prednisolone use and disease duration. RESULTS: Most AAV patients had lower knee extension (76%) and elbow flexion (67%) forces than expected based on healthy norms. Also, physical (P<0.001) and mental (P = 0.01) quality of life were significantly reduced compared to healthy norm values. Lower knee extension force (P = 0.009), younger age <70 (P<0.001) and relapse of vasculitis (P = 0.003) were associated with lower age-adjusted physical quality of life. Lower Baecke index (P = 0.006), higher prednisolone dose (P = 0.005) and ENT involvement (P = 0.006) were associated with lower age-adjusted mental quality of life. Leg muscle strength showed no association with current or cumulative prednisolone use. Disease duration was longer in patients with knee extension force below healthy norms (P = 0.006). CONCLUSION: Knee extension force and physical activity are positively associated with quality of life in AAV. Knee extension force decreases with longer disease duration, suggesting that disease- and treatment-related damage have a cumulative negative effect on muscle strength.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Força Muscular , Músculo Esquelético/fisiopatologia , Qualidade de Vida , Inquéritos e Questionários , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos
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