A practical approach to assess leg muscle oxygenation during ramp-incremental cycle ergometry in heart failure

Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (O2) delivery (i.e., muscle blood flow in non-hypoxemic patients) to meet O2 demands. The resulting increase in fractional O2 extraction can be non-invasively tracked by deoxygenated hemoglobin concentration (deoxi-Hb) as measured by near-infrared spectroscopy (NIRS). We aimed to establish a simplified approach to extract deoxi-Hb-based indices of impaired muscle O2 delivery during rapidly-incrementing exercise in heart failure. We continuously probed the right vastus lateralis muscle with continuous-wave NIRS during a ramp-incremental cardiopulmonary exercise test in 10 patients (left ventricular ejection fraction <35%) and 10 age-matched healthy males. Deoxi-Hb is reported as % of total response (onset to peak exercise) in relation to work rate. Patients showed lower maximum exercise capacity and O2 uptake-work rate than controls (P<0.05). The deoxi-Hb response profile as a function of work rate was S-shaped in all subjects, i.e., it presented three distinct phases. Increased muscle deoxygenation in patients compared to controls was demonstrated by: i) a steeper mid-exercise deoxi-Hb-work rate slope (2.2±1.3 vs 1.0±0.3% peak/W, respectively; P<0.05), and ii) late-exercise increase in deoxi-Hb, which contrasted with stable or decreasing deoxi-Hb in all controls. Steeper deoxi-Hb-work rate slope was associated with lower peak work rate in patients (r=-0.73; P=0.01). This simplified approach to deoxi-Hb interpretation might prove useful in clinical settings to quantify impairments in O2 delivery by NIRS during ramp-incremental exercise in individual heart failure patients.

Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury – A controlled study

OBJECTIVES: Anterior cruciate ligament injury leads to adaptive responses to maintain postural control. However, there is no consensus regarding whether leg dominance also affects postural control in athletes with anterior cruciate ligament injury. The purpose of this study was to evaluate dynamic and static postural control among athletes with and without anterior cruciate ligament injury to the dominant leg. METHODS: Twenty-eight athletes, twenty-one males and seven females aged 15-45 years, were allocated to one of two groups: the anterior cruciate ligament injury group (26±3 years) or the control group without anterior cruciate ligament injury (25±6.5 years). All subjects performed one legged stance tests under eyes open and eyes closed conditions and squat and kick movement tests using a postural control protocol (AccuSwayPlus force platform, Massachusetts). The center of pressure displacement and speed were measured by the force platform. In addition, the distance traveled on the single-leg hop test was assessed as an objective measure of function. RESULTS: Significantly greater mediolateral sway was found under the eyes closed condition (p=0.04) and during squat movement (p=0.01) in the anterior cruciate ligament injury group than in the control group. Analysis of the single-leg hop test results showed no difference between the groups (p=0.73). CONCLUSION: Athletes with anterior cruciate ligament injury had greater mediolateral displacement of the center of pressure toward the dominant leg under the eyes closed condition and during squat movement compared to control athletes.

A new clinical sign probably associated to left hemiplegia with left hemineglect syndrome: the crossed legs / Novo sinal clínico provavelmente associado a hemiplegia esquerda com heminegligência espacial esquerda: as pernas cruzadas

Objective : To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Method : Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular lesions, left hemiplegia but without crossed legs. Results : From 9 patients with persistent tendency to cross the right leg over the left, UNS was detected in 8. One patient died before the clinical tests were applied. Of the 30 patients without the crossed legs, 20 had normal clinical tests for UNS and 10 had minimal alterations, not sufficient for the diagnosis of UNS. Conclusion : The right leg crossed over the left may represent a new neurological semiotic sign associated with left hemiplegia and left UNS. .

Objetivo : Descrever um novo sinal clínico associado à síndrome de negligência unilateral (SNU) em pacientes com acidente vascular cerebral isquêmico (AVCi). Método : Em 150 pacientes com acidente vascular cerebral isquêmico, foram realizadas tomografias de crânio e aplicada a National Institute of Health Stroke Scale. Aqueles pacientes com lesões vasculares à direita, hemiplegia esquerda e perna direita persistentemente cruzada sobre a esquerda, foram submetidos a testes específicos para SNU. Trinta pacientes também com lesões vasculares à direita, hemiplegia esquerda, porém sem evidências de permanecerem com as pernas cruzadas, foram submetidos aos mesmos testes clínicos. Resultados : Entre 150 pacientes com AVCi, 9 apresentaram lesão vascular cerebral à direita, hemiplegia esquerda e tendência em permanecer com a perna direita cruzada sobre a esquerda. Em 8 deles, testes específicos realizados nos primeiros dias de internação, confirmaram SNU à esquerda. Um paciente morreu antes que os testes pudessem ser aplicados. Dos 30 pacientes que não cruzaram as pernas, os testes foram normais em 20. Dez pacientes apresentaram alterações mínimas, insuficientes para o diagnóstico de SNU. Conclusão : A perna direita cruzada sobre a esquerda pode representar um novo sinal semiológico associado à hemiplegia esquerda e SNU à esquerda. .

Influence of additional weight on the frequency of kicks in infants with Down syndrome and infants with typical development

BACKGROUND: Infants with Down syndrome present with organic and neurological changes that may lead to a delay in the acquisition of motor skills such as kicking, a fundamental skill that is a precursor of gait and is influenced by intrinsic and extrinsic factors. Therefore, this movement should be taken into account in early physical therapy interventions in infants. OBJECTIVE: To analyze and to compare the effect of additional weight on the frequency of kicks in infants with Down syndrome and infants with typical development at 3 and 4 months of age. METHOD: Five infants with Down syndrome and five with typical development at 3 and 4 months of age were filmed. The experiment was divided into four experimental conditions lasting 1 minute each: training, baseline, weight (addition of ankle weight with 1/3 the weight of the lower limb), and post-weight. RESULTS: There were significant differences between groups for all variables (p<0.05), with lower frequencies observed for infants with Down syndrome in all variables. There were significant differences between the experimental conditions baseline and post-weight (p<0.001) for both groups in the frequency of contact and success, with a higher frequency in the post-weight condition. CONCLUSIONS: The weight acted as an important stimulus for both groups, directing the kicks toward the target and improving the infants' performance in the task through repetition, however, the infants with Down syndrome had lower frequencies of kicks. .

Strength of the respiratory and lower limb muscles and functional capacity in chronic stroke survivors with different physical activity levels

BACKGROUND: The assessment of strength and its relationships with functional capacity could contribute to more specific and effective disability management of stroke survivors. OBJECTIVE: To compare and investigate associations between measures of strength and functional capacity of 98 chronic stroke survivors, stratified into three groups, according to their physical activity levels. METHOD: The physical activity levels were classified as impaired, moderately active, and active, based on their Human Activity Profile (HAP) scores. Strength was assessed by the maximal inspiratory (MIP) and expiratory (MEP) pressures and by the residual deficits (RDs) of work of the lower limb and trunk muscles, whereas functional capacity was evaluated by the distance covered during the six-minute walking test (6MWT). RESULTS: One-way analyses of variance revealed significant differences between the groups, except between the active and moderately active groups regarding the RDS of the hip and knee flexors/extensors and ankle dorsiflexors (2.91<F<8.62; 0.001<p<0.01). Differences between the groups were found for the 6MWT (F=10.75; p<0.001), but no differences were found for the MIP and MEP measures (0.92<F<2.13; 0.13<p<0.40). Significant, negative, and fair correlations were observed between the RDS of the hip and knee muscles and the 6MWT (0.30<r<-0.43; p<0.01) and the HAP (-0.28<r<-0.41; p<0.01). Moderate to good correlations were found between the 6MWT and the HAP (r=0.50; p<0.0001). There were no significant correlations between measures of respiratory strength and any of the investigated variables (-0.11<r<0.12; 0.26<p<0.56). CONCLUSIONS: Lower strength deficits and higher functional capacity were associated with higher physical activity levels. However, the moderately active and active groups demonstrated similar strength deficits. .

Non-ulcerative soft tissue mycosis of long duration mimicking soft tissue sarcoma--a case report.

Soft tissue mycosis usually presents with a triad of tumefaction, suppuration and ulceration. We report an unusual case of soft tissue mycosis in a 42-year-old male teacher who presented with painless swelling over the anterolateral aspect of the right shin for 4 years duration.

Effects of shoe lift on weight bearing in stroke patients.

OBJECTIVES: To determine the effect of shoe lift, cueing and cueing with shoe lift on weight bearing in paretic leg of stroke hemiparetic patients and compare the effect between each condition. DESIGN: Cross-sectional experimental study. SETTING: Department of Rehabilitation Medicine and Department of Ear Nose and Throat, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University. SUBJECT: Ten hemiparetic patients as a result of unilateral stroke. MATERIAL AND METHOD: Weight symmetry of each patient was measured by posturography during quiet stance and in conditions of compelled weight shift. Each patient was started with quiet standing, standing with shoe lift under the sound leg; cueing and cueing with shoe lift under the sound leg respectively. Weight symmetry scores were recorded for comparing the weight distribution between each foot. RESULTS: There were 10 hemiparetic patients. Seven were male. The average age was 53.4 +/- 8.45 years. There were 5 right hemiparesis and 5 left hemiparesis. The average onset was 12.3 +/- 15.73 months. In the right hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing with shoe lift compared with quiet standing and with shoe lift (Backward p = 0.012, Forward p = 0.011 and Backward p = 0.001, Forward p = 0.036 respectively). In the left hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing compared with quiet standing (Backward p = 0.046), and when using the shoe lift (Backward p = 0.016). Cueing with shoe lift could significantly improve weight bearing in the paretic leg when compared with shoe lift alone (Backward p = 0.015). Shoe lift alone could improve weight bearing in the paretic leg of the right and left hemiparetic patients but was not statistically significant (p > 0.05). CONCLUSION: Cueing with shoe lift under the sound leg can significantly improve weight bearing of the paretic leg of the right and left stroke hemiparetic patients.

Associations of intracompartmental leg pressures and radiographic findings in congenital talipes equinovarus.

The etiopathogenesis of congenital talipes equinovarus remains mysterious. The authors investigated the role of increased intracompartmental leg pressures as a causal relationship with this deformity by measuring the pressures in 25 children aged between 6 months and 1 year with unilateral talipes equinivarus before surgical release. The deep posterior intracompartmental pressure in the leg with talipes equinovarus was greater than the other compartments, and the deep and superficial posterior intracompartmental pressures were also significantly higher than those of the contralateral normal sides (p < 0.05). There were linear correlations between the posterior intracompartmental pressure of affected legs and the Kite index, tibiocalcaneal angle and talo-first metatarsal angle of the affected legs. Deep posterior intracompartmental pressure is a strong predictor of abnormality in the Kite index. The present study showed a probable causal relationship between increased deep posterior intracompartmental pressure and etiopathogenesis of talipes equinovarus.

Infrared Thermographic Imaging in the Assessment of Successful Block on Lumbar Sympathetic Ganglion

This study examined the net changes in temperature at various regions of the lower extremities in an attempt to identify the regions demonstrating the most significant temperature changes following a lumbar sympathetic ganglion block (LSGB). Thermography was performed before and after the LSGB in 26 sympathetic nerve system disorder cases. The inspection points were the anterior and posterior surfaces of the thigh, the knee and leg, and the dorsal and plantar surfaces of the feet. The net increases in skin temperature following the LSGB (deltaT (net) ) at the plantar and dorsal surfaces of the feet, were 6.2 +/- 2.68 degrees C (mean +/- SD) and 3.9 +/- 1.89degrees C, respectively, which were higher than those observed in the other regions of the lower extremities (p < 0.05). The areas, in order of decreasing deltaT (net), are as follows: the plantar surface of the foot, the dorsal surface of the foot, the shin, the anterior surface of the knee, the calf, the posterior surface of the knee, the anterior surface of the thigh, and the posterior surface of the thigh. There was one case of orthostatic hypotension during the thermography procedure. In conclusion, thermographic imaging is a useful method for demonstrating the success of a LSGB in various diseases. An evaluation of the deltaT (net) on the plantar surface of the feet using thermographic imaging is the most effective, simple, and safe method for assessing a successful LSGB.

Tremor ortostático primário: relato de quatro casos / Primary orthostatic tremor: report of 4 cases

Relatamos quatro casos de tremor ortostático primário. O motivo do relato está na raridade da doença e no seu diagnóstico diferencial com outros tremores, muitas vezes confuso. Nossos casos foram estudados eletrofisiologicamente e a frequência dos tremores variou entre 15 e 20 Hz. Existem diferenças clínicas, eletrofisiológicas e terapêuticas entre o tremor ortostático primário e outros tremores de membros inferiores, de acordo com a literatura e com as características de nossos quatro casos.

Aneurisma roto de la arteria poplítea. Reporte de un caso y revisión de la literatura / Rupture of popliteal aneurysm. A case report and review of the literature

Se presenta el caso de un paciente masculino de 62 años de edad, sano, fumador crónico y deportista de golf durante 10 años, cuya primera manifestación fue la presencia de dolor intenso y aumento de volumen progresivo de la extremidad afectada. Se realizaron varios estudios como eco-Doppler, tomografía axial computarizada y arteriografía transoperatoria, encontrando una dilatación aneurismática de 5 cm en la arteria poplítea derecha e infiltración de sangre dentro de los compartimentos posteriores de la pierna. La reparación se efectuó mediante la ligadura del aneurisma y la colocación de un injerto de safena autóloga invertida. El aneurisma de la arteria poplítea afecta a varones en la sexta década de la vida. La etiología es mulivariada. Sus complicaciones más frecuentes son la trombosis, la embolización distal y con menor frecuencia la ruptura. El diagnóstico se establece mediante el cuadro clínico, el eco-Doppler y la tomografía, este último estudio es considerado como el más útil, ya que define el diámetro del aneurisma y la presencia de trombo intramural; la arteriografía se realiza para determinar la permeabilidad de los lechos vasculares proximales y distales a la lesión y elaborar una estrategia quirúrgica. Debido a que esta lesión se asocia con elevados índices de amputación, el tratamiento consiste en la ligadura del aneurisma y revascularización de la extremidad, utilizando la vena safena autóloga como primera opción y el PTFE como material alternativo

Dermatitis microbiana numular / Nummular microbial dermatitis

Introducción. La dermatitis microbiana numular (DMN) se ha reportado en México con una frecuencia de 0.5 a 6 por ciento de la consulta dermatológica. Se realizó este estudio con el objeto de conocer el comportamiento de la DMN en nuestra población. Material y métodos. Se estudiaron retrospectivamente 33 casos, de enero de 1996 a enero de 1997, en el Hospital Infantil de México Federico Gómez. Resultados. La DMN representa el 2.78 por ciento de la consulta de dermatología de primera vez. Predomina en hombres con 63 por ciento de los casos. La edad media fue de 4 años y 10.8 meses con una desviación estándar (DE) de 7.4 meses. La forma diseminada fue la más común, afectando con mayor frecuencia extremidades inferiores. El tiempo de evolución el diagnóstico fue de 8.8 meses con DE de 2.3 meses. Se evidenció foco infeccioso en 79 por ciento de los casos, siendo rinosinusitis y parasitosis los más comunes. La biometría hemática reportó eosinofilia en más de la mitad de los pacientes. Sólo se encontró asociación a dermatitis atópica y atopia en 5 casos. La primavera fue la estación con mayor prevalencia. El tratamiento fue con antibióticos y antiparasitarios sistémicos en 27 pacientes y antihistamínicos en 9. Sólo un paciente requirió esteroide tópico. Más del 70 por ciento evolucionaron satisfactoriamente. Conclusiones. Los hallazgos de este estudio son similares a los referidos en la literatura mundial respecto a epidemiología, cuadro clínico y asociación con enfermedades infecciosas

El valor de las pruebas de elevación de la pierna con la rodilla extendida y de tensión de la extremidad superior en la evaluación de las disfunciones del movimiento / Value of leg raise test with extended knee and upper limb tension in the assessment of movement disfunctions

El presente trabajo efectúa una revisión de los mecanismos que explican la aplicación terapéutica de 2 maniobras de movilización neural. En extremidad superior, por medio del test de elevación de la pierna con la rodilla extendida, y en la superior a través del test de tensión de la extremidad superior. De esta forma se plantea el empleo de estos procedimientos para evaluar la presencia de alteraciones mecánicas (comprensión neural) o neurofisiológicas (inflamación neurogénica y espasmo muscular reflexógeno). La relación entre estos mecanismos y la aplicación de los procedimientos es discutida en profundidad

Miopatía del cuadriceps: una forma de distrofia focal tardía en un caso / Quadriceps myopathy: a from of late focal dystrophy

A 62 years old male with a slowly progressive focal myopathy is presented. He had noticed weakness in the lower limbs of 3 years and weakness in the upper limbs for 1 year. He had bilateral atrophy of quadriceps and biceps muscles, absence of knee jerks and hypertrophy of the calves. Needle EMG showed myopathic motor units. Hystological study was compatible with muscular distrophy. The clinical and laboratory characteristics of the patient are in keeping with what has been described as quadriceps myopathy as a form of a muscular dystrophy

Diagnóstico de las trombosis venosas profundas de las extremidades / Diagnosis of deep venous thrombosis of the extremities

La trombosis venosa profunda de las extremidades es una entidad relativamente frecuente, especialmente en los miembros inferiores. Su complicación más temida es la embolia pulmonar, por el riesgo potencial de muerte cuando es masiva. Se revisan los métodos diagnósticos actuales de las trombosis venosas profundas de las extremidades, fundamentales para realizar un tratamiento oportuno y completo, y para planificar métodos preventivos apropiados. En la actualidad el método ideal es el Eco-Doppler color, o en su defecto el Eco-Doppler en blanco y negro, ya que no sólo entrega información anatómica y funcional de la circulación venosa, sino porque permite evidenciar trombos no oclusivos, trombos flotantes (de alto riesgo embolígeno), y también porque logra discriminar trombos agudos de aquellas oclusiones antiguas, estableciendo el diagnóstico preciso para definir el tratamiento apropiado

pseudo-phlebitis of inferior members

The authors present 18 cases, and study the publications. The hematome of mollet [9 cases], the break of popliteal cyst [5 cases], the superficial phlebitis [3 cases], the venous insufficiency [1 case], are the four differential diagnosis found. The clinical syndroms evoque the diagnosis, but are not specific

Limb salvage procedures for chronic lower limb ischemia

152 limb salvage arterial reconstructions were done for patients with critical ischemia. They included 43 aortailiac, 82 infrainguinal and 15 simultaneous aortailiac and infrainguinal reconstructive procedures as well as 12 percutaneous transluminal angioplasties [PTA]. In aortailiac occlusive disease extraanotomic bypasses were reserved to patients who have a high anaesthetic risk. For infrainguinal bypasses the saphenous vein [reversed or in situ] was the ideal bypass and was used in 83.75 percent. The early mortality rate 7.9 percent and one year patency and salvage rates of 60.6 percent and 65.1 percent respectively were acceptable