Subject(s)
Arthroplasty , Informed Consent , Patient Education as Topic/methods , Humans , Patient Care TeamABSTRACT
Total knee replacement was performed on two patients with Multiple sclerosis. Severe hamstring spasticity was encountered in both patients in the immediate post-operative period requiring further surgery. Both patients remain ambulatory at follow-up. The disease, and its implications in patients warranting total joint replacement are discussed.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Multiple Sclerosis/complications , Muscle Spasticity/etiology , Osteoarthritis, Knee/surgery , Aged , Baclofen/therapeutic use , Braces , Casts, Surgical , Humans , Immobilization , Knee Joint/physiopathology , Knee Joint/surgery , Male , Multiple Sclerosis/physiopathology , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/therapy , Osteoarthritis, Knee/complications , Osteoarthritis, Knee/physiopathology , Range of Motion, Articular/physiology , Tendons/surgeryABSTRACT
An examination of the reproducibility of three tests for identifying patients at risk of diabetic foot complications is reported. One thousand and one patients attending a general diabetic outpatient clinic at the Royal Liverpool University Hospital underwent screening using the Semmes-Weinstein monofilaments, the biothesiometer, and palpation of pedal pulses. Two hundred and fifty-nine patients who were found to have a deficit on at least one of these tests were given a second appointment where the tests were repeated. Two hundred and twenty-nine patients attended for their second appointment. The expected range of variation in readings for the biothesiometer was 5 log hertz, sufficient variation to make the biothesiometer unacceptable as a screening instrument. The range of reproducibility for the four pedal pulses was from 68% to 81%, also an unacceptable level of variation. Over 85% of the results for the Semmes-Weinstein monofilaments were the same on the first and second measurement. Of the three instruments examined in this study, only the Semmes-Weinstein monofilaments have sufficient reproducibility in the clinical setting for them to be recommended for general use as a screening test for risk of diabetic foot complications.
Subject(s)
Ambulatory Care/methods , Diabetic Foot/diagnosis , Mass Screening , Adolescent , Adult , Aged , Aged, 80 and over , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Pulse , Reproducibility of Results , Risk Factors , Sensory Thresholds , VibrationABSTRACT
Intraosseous lipomas are considered to be rare tumours. We describe four cases and discuss their appearances and diagnosis. It is likely with the increasing frequency of computed tomography and magnetic resonance examinations of the lumbar spine that many more asymptomatic lesions will present to the radiologist and that these tumours are not as rare as the literature would suggest.
Subject(s)
Lipoma/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Adult , Female , Humans , Low Back Pain/etiology , Lumbar Vertebrae/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
The development of a shear transducer, small enough to be worn comfortably under a normal foot, is described, along with a microcomputer controlled data logger. Walks up to 8 s can be recorded and the information downloaded to any IBM compatible computer. Software then allows easy analysis of the peak shear stresses. Calibration curves show the transducers to have a linear response up to 35N and preliminary data from the measurement of shear stresses under the normal foot, and their relationship to vertical pressures, is presented. A patent application (number 9109463.1) has been filed for the device in the United Kingdom.
Subject(s)
Foot/physiology , Walking , Adult , Biomechanical Phenomena , Female , Humans , Male , TransducersABSTRACT
Ulceration of the insensitive foot continues to cause great morbidity in diabetic patients. We treated 46 patients with neuropathic ulceration by applying total contact casts. Most neuropathic ulcers healed within six weeks but ischaemic ulcers did not heal. One patient developed gangrene and required partial amputation of the foot.
