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Rev. bras. med. esporte ; 27(3): 262-265, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288590


ABSTRACT Introduction Patients with cerebrovascular accident and hemiplegia need to perform physical exercise and aerobic training, but physical dysfunction restricts the performance of these activities. Objective The article aims to develop physical strength sports for stroke patients with hemiplegia to explore the efficacy of sports to regain limb function in these patients. Methods We randomly selected 30 patients with stroke sequelae and divided them into control and exercise groups. While undergoing rehab, the exercise group performed a certain amount of aerobic exercise. During this period, we compared the relevant physiological indicators of the patients, and, at the same time, we used the Fugle-Meyer motor function scoring method to assess limb function. Results The two groups of patients are significantly different regarding the recovery of physical function and the capacity for daily life. Physiological indicators of patients are also different. Conclusion Low-intensity aerobic exercise can help stroke and hemiplegia patients regain their basic ability to live and exercise. Level of evidence II; Therapeutic studies: investigation of treatment results.

RESUMO Introdução É muito importante que pacientes com acidente vascular encefálico e hemiplegia realizem exercícios físicos e treinamento aeróbio, mas a disfunção física restringe a realização dessas atividades. Objetivo o artigo tem como objetivo desenvolver esportes de força física para pacientes com AVC com hemiplegia para explorar a eficácia dos esportes para recuperar a função dos membros nesses pacientes. Métodos Selecionamos aleatoriamente 30 pacientes com sequela de AVC e os dividimos em grupos controle e exercício. Durante a reabilitação, o grupo de exercícios realmente executou uma certa quantidade de exercícios aeróbicos. Durante esse período, comparamos os indicadores fisiológicos relevantes dos pacientes e, ao mesmo tempo, usamos o método de pontuação da função motora de Fugle-Meyer para avaliar a função dos membros. Resultados Os dois grupos de pacientes são significativamente diferentes em termos de recuperação da função física e capacidade para a vida diária. Os indicadores fisiológicos dos pacientes também são diferentes. Conclusão O exercício aeróbico de baixa intensidade pode ajudar os pacientes com derrame e hemiplegia a recuperar sua capacidade básica de viver e se exercitar. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Es muy importante para los pacientes con accidente cerebrovascular y hemiplejía realizar ejercicio físico y entrenamiento aeróbico, pero la disfunción física restringe la realización estas actividades.Objeto: El artículo tiene como objetivo desarrollar deportes de fuerza física para pacientes con accidente cerebrovascular con hemiplejía para explorar la eficacia de los deportes para recuperar la función de las extremidades de estos pacientes. Métodos Seleccionamos aleatoriamente a 30 pacientes con secuelas por accidente cerebrovascular y los dividimos en grupos de control y de ejercicio. Mientras se sometía a rehabilitación, el grupo de ejercicio llegó a realizar una cierta cantidad de ejercicio aeróbico. Durante este período, comparamos los indicadores fisiológicos relevantes de los pacientes y, al mismo tiempo, utilizamos el método de puntuación de la función motora de Fugle-Meyer para evaluar la función de las extremidades. Resultados Los dos grupos de pacientes son significativamente diferentes en cuanto a la recuperación de la función física y la capacidad para la vida diaria. Los indicadores fisiológicos de los pacientes también son diferentes. Conclusión El ejercicio aeróbico de baja intensidad puede ayudar a los pacientes con accidente cerebrovascular y hemiplejía a recuperar su capacidad básica de vida y ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Humans , Stroke/complications , Exercise Therapy , Stroke Rehabilitation/methods , Hemiplegia/rehabilitation , Treatment Outcome , Extremities
Säo Paulo med. j ; 139(3): 279-284, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1252247


ABSTRACT BACKGROUND: Vitamin D has relationships with pathogenesis and inflammation pathways in many diseases. Its deficiency may make clinicians think not only of supplementation but also of presence of other diseases. OBJECTIVE: To investigate the relationship between vitamin D levels and deep vein thrombosis (DVT), given that reduced levels are related to increased risk of cardiovascular diseases. DESIGN AND SETTING: Case-control study conducted in the cardiovascular surgery and family medicine departments of a hospital in Turkey. METHODS: A total of 280 participants were included: 140 each in the DVT and control groups. Basic clinical characteristics, comorbidities and serum 25-hydroxyvitamin D (25(OH)D) levels were recorded and then compared between the groups. Serum 25(OH)D levels were also evaluated separately in three subgroups (sufficient, insufficient and deficient). RESULTS: Serum 25(OH)D levels were significantly lower in the DVT group than in the controls (P < 0.001). Females in the DVT group had lower 25(OH)D levels than those in the control group (P = 0.002). Nonetheless, the median 25(OH)D level (16.41 ng/ml) of the control group was still below the reference value. Logistic regression analysis showed that 25(OH)D was a significant predictor of DVT. Weight, height and body mass index, which all presented interaction, were significant in the logistic regression analysis but not in individual analyses. CONCLUSION: The serum vitamin D levels of DVT patients were lower than those of controls. If the results obtained from our study are supported by further large-scale randomized controlled trials, vitamin D replacement may be brought into the agenda for protection against DVT.

Humans , Male , Female , Vitamin D/blood , Vitamin D Deficiency/complications , Venous Thrombosis/etiology , Turkey , Case-Control Studies , Extremities
Rev. Col. Bras. Cir ; 48: e20202783, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155358


ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.

Humans , Male , Adult , Tourniquets/statistics & numerical data , Vascular System Injuries/therapy , Exsanguination/prevention & control , Hemorrhage/prevention & control , Emergency Medical Services , Emergency Treatment , Extremities/injuries , Vascular System Injuries/complications , Vascular System Injuries/mortality , Exsanguination/etiology , Exsanguination/mortality , Hemorrhage/etiology , Hemorrhage/mortality
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 880-885, jan.-dez. 2021. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1252853


Objetivo: caracterizar o conhecimento dos agentes comunitários de saúde sobre trauma de extremidades. Método: trata-se de um estudo quantitativo, descritivo, realizado a partir do banco de dados da pesquisa intitulada "conhecimento de agentes comunitários de saúde sobre atendimento pré-hospitalar no suporte básico de vida - impacto das ações de extensão". os dados foram coletados por meio de questionário. a amostra foi composta por 15 agentes comunitários de saúde de uma unidade de saúde da família integrada em João Pessoa, paraíba, brasil. analisaram-se os dados por meio de estatística descritiva e foram apresentados os resultados em tabelas. Resultados: observa-se que a média de acertos no pós-teste sobre conhecimento no trauma de extremidades foi de 69,3%. Conclusão: evidenciou-se que o conhecimento dos agentes comunitários de saúde sobre traumas de extremidades, teve um aumento significativo após as intervenções educativas

Objective: to characterize the knowledge of community health agents about trauma to the extremities. Method: this is a quantitative, descriptive study, carried out from the research database titled "knowledge of community health agents on pre-hospital care in basic life support-impact of extension actions". data were collected through a questionnaire. the sample consisted of 15 community health agents from a integrated family health unit in João Pessoa, Paraíba, Brazil. data were analyzed using descriptive statistics and the results were presented in tables. Results: it was observed that the average of post-test hits in knowledge of extremity trauma was 69.3%. Conclusion: it was evidenced that the knowledge of community health agents on trauma of the extremities, had a significant increase after the educational interventions

Objetivo: caracterizar el conocimiento de los agentes de salud de la comunidad sobre trauma en las extremidades. Método: se trata de un estudio cuantitativo y descriptivo, realizado a partir de la base de datos de investigación titulada "conocimiento de los agentes sanitarios comunitarios sobre la atención prehospitalaria en las acciones básicas de apoyo a la vida-impacto de las acciones de extensión". los datos se recopilaron a través de un cuestionario. la muestra consistió en 15 agentes de salud comunitarios de una unidad integrada de salud familiar en joao pessoa, paraíba, brasil. los datos se analizaron utilizando estadísticas descriptivas y los resultados se presentaron en tablas. Resultados: se observó que el promedio de aciertos posteriores a la prueba en el conocimiento del trauma en las extremidades fue del 69,3%. Conclusión: se evidenizó que el conocimiento de los agentes de salud comunitarios sobre trauma de las extremidades, tuvo un aumento significativo después de las intervenciones educativas

Humans , Male , Female , Adult , Middle Aged , Wounds and Injuries/therapy , Community Health Workers/education , Prehospital Care/methods , Extremities/injuries , Health Centers , First Aid/methods
Article in Chinese | WPRIM | ID: wpr-879826


OBJECTIVE@#To study the clinical features of children with Guillain-Barré syndrome (GBS) and the significance of Brighton criteria in childhood GBS.@*METHODS@#A retrospective analysis was performed on the medical data of 72 children with GBS. Brighton criteria were used for the grading of diagnostic certainty (level 1 as the highest level, and level 4 as the lowest level). A Spearman's rank correlation analysis was used to evaluate the correlation of auxiliary examinations with the level of diagnostic certainty of Brighton criteria.@*RESULTS@#A total of 72 children with GBS were enrolled, with a mean age of onset of (98±32) months. All children (100%, 72/72) had weakness of bilateral limbs and disappearance or reduction of tendon reflex, and limb weakness reached the highest level of severity within 4 weeks. Of all the 72 children, 68 (94%) had positive results of neural electrophysiological examination and 51 (71%) had positive results of cerebrospinal fluid (CSF) examination, and the positive rate of neural electrophysiological examination was significantly higher than that of CSF examination (@*CONCLUSIONS@#Most of the children with GBS meet Brighton criteria level 1, and the positive results of CSF examination and neural electrophysiological examination play an important role in improving the level of diagnostic certainty of Brighton criteria. Neural electrophysiological examination has a higher positive rate than CSF examination in the early stage of the disease.

Child , Child, Preschool , Extremities , Guillain-Barre Syndrome/diagnosis , Humans , Muscle Weakness , Physical Examination , Retrospective Studies
Rev. bras. ortop ; 55(6): 764-770, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156206


Abstract Objective To analyze the anatomical variations of the motor branches of the radial nerve in the elbow region. The origin, course, length, branches, motor points and relationships with neighboring structures were evaluated. Materials and Methods Thirty limbs from15 adult cadavers were dissected and prepared by intra-arterial injection of a 10% glycerin and formaldehyde solution. Results The first branch of the radial nerve in the forearm went to the brachioradialis muscle (BR), originating proximally to the division of the radial nerve into superficial branch of the radial nerve (SBRN) and posterior interosseous nerve (PIN) in all limbs. The branches to the extensor carpi radialis longus muscle (ECRL) detached from the proximal radial nerve to its division into 26 limbs, in 2, at the dividing points, in other 2, from the PIN. In six limbs, the branches to the BR and ECRL muscles originated from a common trunk. We identified the origin of the branch to the extensor carpi radialis brevis muscle (ECRB) in the PIN in 14 limbs, in the SBRN in 12, and in the radial nerve in only 4. The branch to the supinator muscle originated from the PIN in all limbs. Conclusion Knowledge of the anatomy of the motor branches of the radial nerve is important when performing surgical procedures in the region (such as the approach of the proximal third and the head of the radius, release of compressive syndromes of the posterior interosseous nerve and radial tunnel, and distal nerve transfers) in order to understand the order of recovery of muscle function after a nerve injury.

Resumo Objetivo Analisar as variações anatômicas dos ramos motores do nervo radial na região do cotovelo. Foram avaliadas a origem, curso, comprimento, ramificações, pontos motores e relações com estruturas vizinhas. Materiais e Métodos Foram dissecados 30 membros de 15 cadáveres adultos, preparados por injeção intra-arterial de uma solução de glicerina e formol a 10%. Resultados O primeiro ramo do nervo radial no antebraço foi para o músculo braquiorradial (BR), que se origina proximalmente à divisão do nervo radial em ramo superficial do nervo radial (RSNR) e nervo interósseo posterior (NIP) em todos os membros. Os ramos para o músculo extensor radial longo do carpo (ERLC) se desprenderam do nervo radial proximalmente à sua divisão em 26 membros, em 2, nos pontos de divisão, em outros 2, do NIP. Em seis, os ramos para os músculos BR e ERLC originavam-se de um tronco comum. Identificamos a origem do ramo para o músculo extensor radial curto do carpo (ERCC) no NIP em 14 membros, no RSNR em 12, e no nervo radial em apenas 4. O ramo para o músculo supinador originou-se do NIP em todos os membros. Conclusão O conhecimento da anatomia dos ramos motores do nervo radial é importante quando se realizam procedimentos cirúrgicos na região, como a abordagem do terço proximal e da cabeça do rádio, a liberação das síndromes compressivas do nervo interósseo posterior e do túnel radial, as transferências nervosas distais, e para entender a ordem de recuperação da função muscular após uma lesão nervosa.

Radial Nerve , Radius , Surgical Procedures, Operative , Wrist , Cadaver , Nerve Transfer , In Situ Nick-End Labeling , Elbow , Extremities , Forearm , Forearm Injuries , Glycerol , Head , Anatomy , Injections, Intra-Arterial
Med. U.P.B ; 39(2): 11-16, 21/10/2020. tab, mapas
Article in Spanish | LILACS, COLNAL | ID: biblio-1123559


Objetivo: Caracterizar la atención de accidentes de tránsito en la ciudad de Medellín para obtener una imagen general de la situación de salud en este contexto. Metodología: Estudio descriptivo observacional, con intención analítica, de fuentes secundarias de información, en pacientes con edad mayor o igual a 16 años, atendidos por el personal 123, módulo salud, víctimas de accidentes de tránsito en Medellín. Resultados: Un total de 3 829 individuos sufrieron accidente de tránsito entre octubre y diciembre del 2018 según los criterios del estudio. De estos, el 63.1% de sexo masculino, con edad media de 34 años. La zona con mayor demanda de atención prehospitalaria fue la comuna 10 de la ciudad (La Candelaria) y la mayoría de los afectados por los accidentes lo fueron en calidad de conductor, 64%, y en un 75% de los casos, el vehículo involucrado fue una motocicleta. Solo el 26.5% de los pacientes fueron dados de alta en la escena. Las extremidades fueron las zonas corporales de mayor compromiso, en un 78.2% de los episodios, seguidas por el cráneo y la cara, con un 26.8%. Conclusiones: Es evidente la necesidad de la ciudad de implementar y evaluar el impacto de estrategias dinámicas que permitan un manejo eficiente de los recursos, que priorice las zonas y grupos demográficos de mayor riesgo y la articulación de la disposición de pacientes dentro de la cadena de atención, según los tipos más frecuentes de lesiones.

Objective: To characterize the traffic accident attention in the city of Medellín in order to obtain a general image of the health situation in this context. Methodology: Observational descriptive study, with analytic intent, of secondary information sources in patients with age higher or equal to 16 years of age, served by the 123 personnel, health module, who were victims of traffic accidents in Medellín. Results: A total of 3 829 individuals suffered traffic accidents between October and December of 2018 according to the study criteria. Of these, 63.1% were males, with an average age of 34 years old. The zone with the highest demand of pre-hospital attention was the Comuna 10 of the city (known as La Candelaria) and most of the affected by the accidents were as drivers, 64%, and 75% of the cases, the vehicle involved was a motorcycle. Only 26.5% of the patients were discharged on the scene. The extremities were the body zones with the highest compromise in 78.2% of the episodes, followed by the cranium and the face, with 26.8%. Conclusions: It is evident that the city needs to implement and evaluate the impact of dynamic strategies that enable an efficient management of the resources that prioritizes the zones and demographic groups with the highest risk and the articulation of the disposition of patients within the attention chain, according to the most frequent types of injuries.

Objetivo: Caracterizar a atenção de acidentes de trânsito na cidade de Medellín para obter uma imagem geral da situação de saúde neste contexto. Metodologia: Estudo descritivo observacional, com intenção analítica, de fontes secundárias de informação, em pacientes com idade maior ou igual a 16 anos, atendidos pelo pessoal 123, módulo saúde, vítimas de acidentes de trânsito em Medellín. Resultados: Um total de 3 829 indivíduos sofreram acidente de trânsito entre outubro e dezembro de 2018 segundo os critérios do estudo. Destes, 63.1% de sexo masculino, com idade média de 34 anos. A região com maior demanda de atenção pré-hospitalar foi a comuna 10 da cidade (La Candelaria) e a maioria dos afetados pelos acidentes foram em qualidade de condutor, 64%, e num 75% dos casos, o veículo envolvido foi uma motocicleta. Só 26.5% dos pacientes foram dados de alta na cena. As extremidades foram as zonas corporais de maior compromisso, em 78.2% dos episódios, seguidas pelo crâneo e a cara, com um 26.8%. Conclusões: É evidente a necessidade da cidade de implementar e avaliar o impacto de estratégias dinâmicas que permitam um manejo eficiente dos recursos, que priorize as zonas e grupos demográficos de maior risco e a articulação da disposição de pacientes dentro da cadeia de atenção, segundo os tipos mais frequentes de lesões.

Humans , Accidents, Traffic , Prehospital Care , Extremities , Craniocerebral Trauma , Health Resources
Int. j. morphol ; 38(5): 1485-1495, oct. 2020. graf
Article in English | LILACS | ID: biblio-1134466


SUMMARY: Axolotl limb regeneration is a fascinating characteristic that has attracted attention for several decades. Our previous studies on axolotl limb regeneration indicated that the satellite cells in the remnant muscles move distally into the blastema to regenerate new muscles that are separated by a gap from remnant muscles. Thereafter, the regenerative muscle fibers start to reconnect with remnant ones. In this study, the reconnection at the individual muscle fiber level was elucidated to test the hypothesis that this reconnection happens synchronously among involved muscles. Three pairs of EGFP+ mid-bud stage blastemas were transplanted onto freshly amputated stumps of RFP+ axolotls at the same thigh position to generate double fluorescence chimeric regenerative hindlimbs. These regenerative limbs were harvested very late far beyond they had reached the late differentiation stage. Fluorescence imaging of these limbs in cross sections revealed that in the proximal remnant part of the muscle fiber, reconnection occurred at a different pace among the muscles. In the major thigh muscle gracilis, the reconnection started from the periphery before it was completed. Furthermore, RFP+ muscle fibers contributed to muscle regeneration in the distal regenerative parts. Intriguingly, this red cell contribution was limited to ventral superficial muscles of the calf. This kind of double fluorescence chimeric limb regeneration model may help increase the understanding of the patterning of axolotl limb regeneration in late stages.

RESUMEN: La regeneración del miembro de Axolotl es una característica fascinante que ha llamado la atención durante varias décadas. Nuestros estudios previos sobre la regeneración del miembro del Axolotl indicaron que las células satélite en los músculos remanentes se mueven distalmente hacia el blastema para regenerar nuevos músculos que están separados por una brecha de músculos remanentes. A partir de entonces, las fibras musculares regenerativas comienzan a reconectarse con las restantes. En este estudio, se aclaró la reconexión a nivel de fibra muscular individual para probar la hipótesis de que esta reconexión ocurre sincrónicamente entre los músculos involucrados. Se trasplantaron tres pares de blastemas EGFP+ en la etapa de yema media en tocones recién amputados de axolotls RFP+ en la misma posición del muslo para generar miembros posteriores regenerativos quiméricos de fluorescencia doble. Estos miembros regenerativos se cosecharon muy tarde mucho más allá de haber alcanzado la etapa de diferenciación tardía. Las imágenes de fluorescencia de estos miembros en secciones transversales revelaron que en la parte remanente proximal de la fibra muscular, la reconexión se produjo a un ritmo diferente entre los músculos. En el músculo grácil, la reconexión comenzó desde la periferia antes de completarse. Además, las fibras musculares RFP+ contribuyeron a la regeneración muscular en las partes regenerativas distales. Curiosamente, esta contribución de glóbulos rojos se limitó a los músculos superficiales ventrales de la pantorrilla. Este tipo de modelo de regeneración quimérica de doble fluorescencia del miembro puede ayudar a aumentar la comprensión del patrón de la regeneración del miembro del Axolotl en etapas tardías.

Animals , Regeneration/physiology , Extremities/physiology , Ambystoma mexicanum/physiology , Animals, Genetically Modified , Cell Transplantation , Fluorescence
Health Sciences Journal ; : 26-29, 2020.
Article in English | WPRIM | ID: wpr-876157


@#Introduction: Interdigital pilonidal sinus is an acquired condition secondary to penetration of hair fragments into the skin of the web spaces of the hands commonly observed in hairdressers, and occasionally, among pet groomers. Local literature reports or guidelines to ensure practice of protective measures for this population of workers are currently lacking. Case Summary: A 24-year old pet groomer consulted due to occasional white hair strands emerging from two openings in the third interdigital space of his dominant hand. Histopathologic examination of the sinus tract showed an acanthotic, hyperplastic epidermis with scale crust, and nodular dermal infiltrates composed of epithelioid histiocytes, plasma cells, lymphocytes, and eosinophils. Transepidermal extrusion of polarizable hair cortical material was also evident establishing the diagnosis of an interdigital pilonidal sinus. Sinusectomy and debridement with healing by secondary intention resulted in an optimal wound closure and full motion of the affected hand after one week and minimal scarring with no recurrence after seven months. Conclusion: Surgical excision followed by proper wound care is essential to avoid recurrence. In conclusion, since interdigital pilonidal disease is a rare condition, awareness among physicians would lead to accurate diagnosis, optimal treatment, and proper patient education.

Occupational Diseases , Grooming , Extremities , Pilonidal Sinus
Article in English | WPRIM | ID: wpr-786216


Therapeutic angiogenesis is an important strategy to rescue ischemic tissues in patients with critical limb ischemia having no other treatment option such as endovascular angioplasty or bypass surgery. Studies indicated so far possibilities of therapeutic angiogenesis using autologous bone marrow mononuclear cells, CD34⁺ cells, peripheral blood mononuclear cells, adipose-derived stem/progenitor cells, and etc. Recent studies indicated that subcutaneous adipose tissue contains stem/progenitor cells that can give rise to several mesenchymal lineage cells. Moreover, these mesenchymal progenitor cells release a variety of angiogenic growth factors including vascular endothelial growth factor, fibroblast growth factor, hepatocyte growth factor and chemokine stromal cell-derived factor-1. Subcutaneous adipose tissues can be harvested by less invasive technique. These biological properties of adipose-derived regenerative cells (ADRCs) implicate that autologous subcutaneous adipose tissue would be a useful cell source for therapeutic angiogenesis in humans. In this review, I would like to discuss biological properties and future perspective of ADRCs-mediated therapeutic angiogenesis.

Angioplasty , Bone Marrow , Extremities , Fibroblast Growth Factors , Hepatocyte Growth Factor , Humans , Intercellular Signaling Peptides and Proteins , Ischemia , Mesenchymal Stem Cells , Stem Cell Transplantation , Stem Cells , Subcutaneous Fat , Vascular Endothelial Growth Factor A
Article in English | WPRIM | ID: wpr-786140


Kawasaki disease (KD) is an acute febrile illness that is characterized by systemic inflammation usually involving medium-sized arteries and multiple organs during the acute febrile phase, leading to associated clinical findings. The diagnosis is based on the principal clinical findings including fever, extremity changes, rash, conjunctivitis, oral changes, and cervical lymphadenopathy. However, KD diagnosis is sometimes overlooked or delayed because other systemic organ manifestations may predominate in acute phase of KD. As a cardiovascular manifestation, an acute pericarditis usually shows a small pericardial effusion, but large pericardial effusion showing clinical signs of cardiac tamponade is very rare. Here, we described a case of incomplete KD presenting with impending cardiac tamponade, and recurrent fever and pleural effusion.

Arteries , Cardiac Tamponade , Conjunctivitis , Diagnosis , Exanthema , Extremities , Fever , Inflammation , Lymphatic Diseases , Mucocutaneous Lymph Node Syndrome , Pericardial Effusion , Pericarditis , Pleural Effusion
Rev. argent. cir ; 112(2): 157-164, 2020. tab
Article in English, Spanish | LILACS | ID: biblio-1125796


Antecedentes: los melanomas en cabeza y cuello (MCC) han sido asociados con factores pronósticos diferentes de aquellos en otras localizaciones. Objetivo: comparar características demográficas, clínicas y resultados del tratamiento quirúrgico de pacientes con MCC y pacientes con melanomas en tronco y extremidades (MTE). Material y métodos: se llevó a cabo una revisión retrospectiva de las historias clínicas de pacientes operados por melanoma entre enero de 2012 y diciembre de 2017. Quince pacientes (22,3%) tuvieron MCC y 52 (77,7%) MTE. Resultados: ambos grupos tuvieron edad similar (63,8 ± 21,1 versus 58,5 ± 16), pero los MCC mostraron una tendencia con predominio masculino (80% versus 61,3%). Los MCC tuvieron menor espesor tumoral que los MTE (2,07 versus 5,5 mm) y mayor porcentaje de melanoma in situ, 5 (33,3%) versus 8 (15,3%), pero requirieron vaciamientos ganglionares más a menudo (33% versus 25%) así como reconstrucción del defecto primario con colgajos locales y miocutáneos. Durante el seguimiento, en el grupo de MCC, dos pacientes desarrollaron recidivas locales que fueron extirpadas, y otros tres desarrollaron metástasis a distancia en pulmón, intestino delgado y abdomen y fallecieron por la enfermedad; en el grupo de MTE un paciente tuvo recidiva local y cinco fallecieron de metástasis sistémicas. El tamaño de la muestra no permitió aplicar pruebas de significación entre las diferencias encontradas. Conclusión: los MCC se presentan en un amplio rango de edad y estadios, y tuvieron algunas diferencias clínicas con el MTE. Los defectos producidos por la extirpación de la lesión primaria requieren procedimientos reconstructivos más complejos la mayoría de las veces y se aconseja un abordaje multidisciplinario.

Background: Head and neck melanomas (HNMs) have been associated with prognostic factors different from those on other locations. Objective: The goal of the present study was to compare the demographic and clinical characteristics and the outcomes of surgical treatment between patients with HNM and those with trunk and extremity melanoma (TEM). Material and methods: The clinical records of patients undergoing surgery for melanoma between October 2014 and April 2018 were retrospectively reviewed. Fifteen patients (22.3%) had HNM and 52 (77.7) presented TEM. Results: There were no differences in age between both groups (63.8 ± 21.1 versus 58.5 ± 16), but there was a trend toward higher percentage of men in the HNM group (80% versus 61.3%). Patients with HNM had lower tumor thickness than those with TEM (2.07 versus 5.5 mm), higher incidence of melanoma in situ [5 (33.3%) versus 8 (15.3%)]; lymph node resection was more common (33% versus 25%) as well as reconstruction of the primary defect with local and musculocutaneous flaps. During follow-up, two patients in the HNM group developed local recurrences that were excised and three presented distant metastases in the lung, small bowel and abdomen and finally died due to the disease. In the TEM group, one patient had local recurrence and five died due to systemic metastases. The sample size was not sufficient to assess statistically significant differences. Conclusion: Head and neck melanomas occur in a wide age range and stages and has some clinical differences with TEM. The defects produced after the excision of the primary lesion often require more complex procedures and should be managed with a multidisciplinary approach.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Head and Neck Neoplasms/epidemiology , Melanoma/epidemiology , Cross-Sectional Studies , Retrospective Studies , Sentinel Lymph Node Biopsy , Extremities/pathology , Torso/pathology , Margins of Excision , Melanoma/surgery
Yonsei Medical Journal ; : 235-242, 2020.
Article in English | WPRIM | ID: wpr-811472


PURPOSE: To characterize associated reactions (ARs) in the contralateral arm across multiple muscles during unimanual tasks and to identify factors related to ARs in children with cerebral palsy (CP).MATERIALS AND METHODS: This was a prospective, cross-sectional study of 35 children with CP. The extent of ARs of the contra-lateral, non-task hand was assessed while performing three unimanual tasks (opening and clenching the fist, a finger opposition task, and tapping fingers). The occurrence of ARs in each trial was evaluated separately for each task using a four-point scale (total scores ranged from 0 to 12). Surface electromyography (SEMG) was used to measure the firing activity of the muscles of the opposite arm during the task. The Manual Ability Classification System and Melbourne Assessment 2 (MA-2) were used to evaluate upper limb function.RESULTS: AR scores were higher in the more-affected limb than in the less-affected limb. SEMG data on the non-task hand showed motor overflow up to the elbow muscles in the more-affected limb. Root mean square ratios of EMG signals were significantly higher in children with ARs than in children without ARs. Multiple regression analysis showed both age and MA-2 to be significant factors related to ARs in the more-affected limb.CONCLUSION: Children with visible ARs showed motor overflow in the non-task limb during unimanual hand tasks. Age and upper limb function were significantly related to the extent of ARs in the more-affected limb of children with CP.

Arm , Cerebral Palsy , Child , Classification , Cross-Sectional Studies , Elbow , Electromyography , Extremities , Fingers , Fires , Hand , Humans , Muscles , Prospective Studies , Upper Extremity
Yonsei Medical Journal ; : 251-256, 2020.
Article in English | WPRIM | ID: wpr-811470


PURPOSE: This study aimed to evaluate the validity of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) for the assessment of musculoskeletal disorders. We evaluated whether WOMAC-SF correlated with the World Health Organization Disability Assessment Schedule 12 (WHODAS-12) and Kaigo-Yobo questionnaires for assessing health-outcomes in Korea.MATERIALS AND METHODS: This cross-sectional study used data from the Namgaram-2 cohort. WOMAC, WOMAC-SF, WHODAS-12, and Kaigo-Yobo questionnaires were administered to patients with musculoskeletal disorders, including radiology-confirmed knee osteoarthritis (RKOA), sarcopenia, and osteoporosis. The relationships among WOMAC-SF, WHODAS-12, and Kaigo-Yobo scores were analyzed by stepwise multiple regression analysis.RESULTS: WOMAC-SF was associated with the WOMAC questionnaire. The results of confirmatory factor analysis for the hypothesized model with two latent factors, pain and function, provided satisfactory fit indices. WOMAC-SF pain and function were associated with RKOA. Kaigo-Yobo was associated with WOMAC-SF pain (B=0.140, p=0.001) and WOMAC-SF function (B=0.042, p=0.004). WHODAS-12 was associated with WOMAC-SF pain (B=0.679, p=0.003) and WOMAC-SF function (B=0.804, p<0.001).CONCLUSION: WOMAC-SF was validated for the evaluation of low extremity musculoskeletal disorders and health-related quality of life in a community-based population. Furthermore, we confirmed that WOMAC-SF were reflective of disability and frailty, which affect health outcomes.

Appointments and Schedules , Arthritis , Cohort Studies , Cross-Sectional Studies , Extremities , Humans , Korea , Ontario , Osteoarthritis, Knee , Osteoporosis , Quality of Life , Sarcopenia , World Health Organization
Article in Korean | WPRIM | ID: wpr-811247


Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.

Analgesics, Opioid , Anticonvulsants , Arm , Benzodiazepines , Diagnosis , Dopamine Agonists , Extremities , Hand , Humans , Immobilization , Iron , Leg , Paresthesia , Polysomnography , Pregabalin , Pregnancy , Restless Legs Syndrome , Sleep Wake Disorders , Uremia
Article in English | WPRIM | ID: wpr-811182


In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of −2.5 and −2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.

Adult , Alkaline Phosphatase , Biopsy , Bone Density , Calcium , Collagen Type I , Diagnosis , Diphosphonates , Early Diagnosis , Extremities , Female , Follow-Up Studies , Heel , Humans , Osteitis Deformans , Osteocalcin , Osteoporosis , Parathyroid Hormone , Radiography , Radius , Specialization , Wrist
Rev. argent. neurocir ; 33(4): 242-244, dic. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1177068


Introducción: Las Schwannomatosis Mononeurales de los Miembros son entidades muy poco frecuentes, escasamente conocidas y raramente publicadas en la bibliografía internacional, éstas se encuentran caracterizadas por la existencia de múltiples formaciones nodulares o plexiformes con compromiso exclusivo de un solo nervio, todas con diagnóstico patológico de schwannoma, excluyéndose a otras entidades tumorales y fuera del contexto de una neurofibromatosis. Aquí se presenta un caso con compromiso del nervio plantar medial o interno. Material y método: Se evaluó y analizo el caso clínico, a nivel semiológico y Neurorradiológico, Neurofisilógico. Se definió la conducta terapéutica y quirúrgica. Se evaluaron resultados mediante: análisis semiológico y seguimiento con imágenes. Descripción y resultados: Paciente sexo masculino de 45 años de edad consulta por presentar múltiples tumoraciones palpables en región retromaleolar interna y plantar derecho y disestesias al apoyo, con antecedente de cirugía de schwannoma plantar. Al examen neurológico: masas palpables en los sectores previamente indicados y Tinel a nivel retromaleolar interno y plantar. RMN: múltiples nódulos con captación intermedia de contraste, hipertensos en T2.Se practicó resección quirúrgica mediante amplio abordaje, se identificaron múltiples nódulos, uno de ellos de aspecto plexiforme que involucraba la totalidad del nervio plantar interno imposibilitando la preservación del tronco por lo cual se practicó microneurorrafia con interposición de puente de safeno interno. Discusión y conclusión: Las Schwannomatosis Mononeurales de los Miembros son entidades extremadamente raras, se han reportado con una frecuencia un poco mayor a aquellas que involucran a los nervios mediano y cubital, en sus características macroscópicas las lesiones fueron publicadas como pertenecientes a la variante nodular para esa escasa mayoría. La configuración plexiforme de los schwannomas es menos frecuente que la nodular per se y, en general. está asociada a troncos menores, fuera de estos territorios, su rareza es extrema. Este caso clínico resulta aún más especial por tratarse de una Schwannomatosis Mononeural del Plantar Medial con variante de tipo mixto, es decir nodular con una masa plexiforme dominante. Esta entidad no la hemos encontrado en la bibliografía internacional.Por otro lado, la resección quirúrgica de estos tumores, cuando son nodulares es compatible con la preservación del tronco nervioso, sacrificando solamente, su fascículo de origen. Este caso, dada la configuración descripta del tumor principal, el cual involucraba la totalidad del tronco, se hizo imposible la preservación del nervio, para lo cual debió realizarse microneurorrafia con puente. Como consideración final, creemos que es de capital importancia la adecuada exploración y planificación pre e intraoperatoria de estos pacientes

Introduction: Mononeural Schwannomatosis located at limbs are very infrequent entities, the knowledge about its are very poor, and there are just a few publications related to them. This articles make reference multiple nodular or plexiform lesions with involvement oh only one nerve, every one whit diagnosis of schwannoma, excluding fibromatosis. In this article, we describe a patient with who suffered the involvement of multiples tumours with nodular and plexiform configuration. Material y method: The clinical case was analysed by different media, clinical, neuro physiological and by neuroimages. By this approaches were defined and evaluated the surgical outcomes and results. Clinical case: Male, 45 years old. Multiples tumours at plantar region. Tinel Sign with multiple palpable masses al retromaleolar sulcus and plantar region, plantar schwannoma operated on previously.RMN: multinodular configuration at level of medial plantar nerve, with intermediate contrast reinforcement.An extended approach was performed, from retromaleolar sulcus to medial aspect of the foot, and finishing inside the digital-plantar sulcus. Complete resection was performed, multiples nodulos were found, the bigger had a plexiform configuration, was imposible the preservation of the nerve trunk and the, the interposition of sural nerve was realized. With good evolution. Conclusions: For this very rare entities, the bigger frequency was reported et limbs.The most frequent locations was at medial nerve, second place occupied by the ulnar nerve, we didn't find on international literature a plexiform tumour inside the medial plantar nerve.On the other hand, we think that the complete resection for this tumours when are nodular, the complete resection with preservation of the main trunk, is feasible. Ehen the tumour has a plexiform pattern; complete resection is only feasible with trunk nerve resection and interposition of nerve graft

Humans , Male , Neurilemmoma , Sural Nerve , General Surgery , Tibial Nerve , Ulnar Nerve , Extremities , Foot