ABSTRACT
Injury recidivism among trauma patients may be related to an individual pattern of high risk behaviors. The extent to which an injury episode modifies this behavior pattern is unknown. A self report, voluntary, anonymous, cross sectional survey was administered to motorcycle and all-terrain vehicle (ATV) riders at a popular recreation site. Data included demographics, injury history, and current usage of helmet and protective gear. Two hundred eighty surveys were completed. History of ATV/motorcycle related minor and major injury were reported by 21% and 9%, respectively. Persons with a history of minor ATV/motorcycle injury only were less likely to use a helmet or protective equipment (78% v 74%, p = 0.58 and 49% v 41%, p = 0.29). Persons with a history of any major ATV/motorcycle injury were also less likely to use a helmet or protective equipment (77% v 56%, p = 0.03 and 48% v 40%, p = 0.53). These findings suggest a pattern of persistent high risk behavior among previously injured persons.
Subject(s)
Head Protective Devices/statistics & numerical data , Motorcycles , Off-Road Motor Vehicles , Protective Clothing/statistics & numerical data , Wounds and Injuries/prevention & control , Accident Proneness , Accidents, Traffic/psychology , Adolescent , Adult , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Risk-Taking , Wounds and Injuries/psychologyABSTRACT
BACKGROUND: High-quality preoperative radiographic evaluation is crucial in selecting patients with periampullary carcinomas who are candidates for surgical exploration and tumor resection while minimizing the rate of unnecessary laparotomy. METHODS: Twenty-one consecutive patients were prospectively investigated using helical computed tomography (CT) scanning, endoscopic ultrasonography (EUS), and selective visceral angiography (SVA) to determine tumor resectability. All patients were explored and resectability determined. RESULTS: Helical CT had a sensitivity of 63%, a specificity of 100%, and an overall accuracy of 86%. EUS had a sensitivity of 75%, a specificity of 77%, and an overall accuracy of 76%. SVA had a sensitivity of 38%, a specificity of 92%, and an overall accuracy of 71%. CONCLUSIONS: Helical CT scanning is the best preoperative imaging test to determine tumor resectability. EUS is more sensitive than CT for tumor detection, but underestimates resectability. SVA is no longer helpful in the preoperative evaluation of these malignancies.
Subject(s)
Pancreatic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Aged , Angiography , Endoscopy , Female , Humans , Male , Middle Aged , Neoplasm Staging , Pancreatic Neoplasms/pathology , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/methods , UltrasonographyABSTRACT
Prolonged or crash dieting should be recognized as a cause of peroneal neuropathy or foot drop. The author presents seven examples in patients.
Subject(s)
Foot/innervation , Peripheral Nervous System Diseases/physiopathology , Peroneal Nerve/physiopathology , Weight Loss/physiology , Adult , Aged , Aged, 80 and over , Child , Electromyography , Female , Humans , Male , Middle Aged , Peripheral Nervous System Diseases/diagnosisABSTRACT
Three healthy men were engaged in continuous repetitive arm exercise when a sudden forceful contraction and stretch of the arm muscles led to a delayed upper arm radial nerve palsy. Radial nerve "entrapment" at the lateral head of the triceps muscles is a recognizable occupational nerve injury.
Subject(s)
Muscles/physiology , Paralysis/etiology , Physical Exertion , Radial Nerve , Action Potentials , Adult , Electromyography , Evoked Potentials , Humans , Male , Median Nerve/physiopathology , Movement , Muscles/physiopathology , Neural Conduction , Paralysis/physiopathology , Sensation/physiology , Ulnar Nerve/physiopathologySubject(s)
Myotonia Congenita/physiopathology , Neuromuscular Diseases/physiopathology , Adult , Diagnosis, Differential , Electromyography , Female , Humans , Male , Myotonia Congenita/diagnosis , Myotonia Congenita/drug therapy , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/drug therapyABSTRACT
A secretary/typist developed work-related pain along the hypothenar aspect of the dominant hand. This was later followed by involuntary, finally continuous tremorous movements of the 4th and 5th fingers. Electromyographic abnormalities were limited to myokymia of 3rd and 4th interossei muscles. Surgical decompression of Guyon's canal with removal of the pisiform bone resulted in a complete cure.
Subject(s)
Fasciculation/etiology , Fingers , Tremor/etiology , Ulnar Nerve , Female , Humans , Middle Aged , Peripheral Nervous System Diseases/complications , Ulnar Nerve/physiopathologyABSTRACT
Two male patients from a single family with known PC and "potassium sensitivity" developed hypokalemic paralysis following generalized anesthesia. These patients confirm previous similar observations. It's significance and management are discussed.
Subject(s)
Hyperkalemia/physiopathology , Hypokalemia/physiopathology , Myotonia Congenita/physiopathology , Potassium/metabolism , Adult , Humans , Hyperkalemia/complications , Hypokalemia/complications , Male , Myotonia Congenita/complications , Physical Exertion , Potassium/bloodSubject(s)
Poliomyelitis/physiopathology , Adult , Exercise , Female , Humans , Male , Middle Aged , Muscular Atrophy/etiology , Poliomyelitis/therapy , Syndrome , Time FactorsABSTRACT
Two patients with 'benign' congenital muscular dystrophy (CMD) have been observed for several years. Symptoms and signs of central nervous system (CNS) disease occurred at the age of 7 and 16 years, respectively. CNS involvement in CMD may be more common than generally recognized, slowly progressive and delayed in onset. The combination of congenital hypotonia, contractures, 'dystrophic' muscle biopsy changes and diffuse subcortical hypodensity on computed-tomographic scans seems unique and specific for CMD and of differential diagnostic significance.
Subject(s)
Central Nervous System Diseases/etiology , Muscular Dystrophies/congenital , Adult , Child , Female , Humans , Male , Muscular Dystrophies/complications , Muscular Dystrophies/diagnostic imaging , Muscular Dystrophies/pathology , Tomography, X-Ray ComputedSubject(s)
Myotonic Dystrophy/genetics , Adult , Aged , Aged, 80 and over , Electromyography , Female , Genetic Carrier Screening , Humans , Male , Middle Aged , Myotonic Dystrophy/physiopathologyABSTRACT
Recent advances in neuromuscular diseases have also widened the diagnostic spectrum of myotonic disorders. Treatment, prognosis, and genetic aspects are different in the various syndromes and mandate a correct diagnosis. The combination of neurologic examination, standard EMG, exercise test, cold exposure, potassium loading, eye examination, and pedigree analysis allows correct classification of nearly all patients with myotonic disorders. In this review emphasis is placed on clinical features and electrophysiologic evaluation.
Subject(s)
Myotonia/diagnosis , Diagnosis, Differential , Electromyography , Humans , Myotonia Congenita/diagnosis , Myotonic Dystrophy/diagnosis , Paralyses, Familial Periodic/diagnosis , Paresis/etiology , SyndromeABSTRACT
Seven patients with paramyotonia congenita (PC) from two families were studied. Voluntary exercise of the hand muscles was performed at different hand temperatures, both before and after treatment with tocainide. All patients developed stiffness, prolonged weakness, and small compound muscle action potentials (CMAPs) following exercise; the temperature at which this occurred was individually different. Two patients with PC and associated episodes of generalized weakness underwent potassium loading. A prolonged exercise test was performed both immediately before and 90 minutes after K-loading. Exercise-induced weakness and CMAP-decline occurred only with high serum K levels. Thiazide treatment in these two patients was ineffective. All seven patients responded well to tocainide. Treatment response and side effects were dose-dependent. Good clinical improvement has been maintained in all patients for more than 6 months, with relatively small doses of tocainide (400-1200 mg/day).
Subject(s)
Lidocaine/analogs & derivatives , Myotonia Congenita/physiopathology , Action Potentials/drug effects , Adult , Exercise Test , Female , Humans , Lidocaine/adverse effects , Lidocaine/therapeutic use , Male , Myotonia Congenita/drug therapy , Myotonia Congenita/genetics , Potassium/blood , Temperature , TocainideABSTRACT
We investigated the diagnostic value of electromyographic (EMG) examination of the anterior abdominal wall muscles (AWMS) in thoracic radiculopathy and compared it with examination of thoracic paraspinal muscles (TPSM). Technically, examination of AWMS was much easier compared to TPSM. In eight patients with thoracic diabetic radiculopathy at the level of T7-T12, AWMS was abnormal in all and was considered to be diagnostic, whereas AWMS was normal in diabetic lumbar radiculopathy, patients with diabetes mellitus without radiculopathy, patients with unspecified gastrointestinal pain, and patients with musculoskeletal-type back pain. We conclude that EMG evaluation for possible thoracic radiculopathy should include examination of AWMS, and if abnormal, would be of great diagnostic help in patients with unspecified gastrointestinal symptoms.
Subject(s)
Diabetic Neuropathies/diagnosis , Electromyography , Radiculopathy/diagnosis , Abdominal Muscles/innervation , Adult , Aged , Back Pain/diagnosis , Female , Gastrointestinal Diseases/diagnosis , Humans , Male , Middle Aged , Muscles/innervation , Neuromuscular Diseases/diagnosisABSTRACT
A patient with recessive generalized congenital myotonia and severe, disabling weakness underwent various forms of treatment while being monitored electrophysiologically. Phenytoin, verapamil, and acetazolamide were ineffective, but tocainide yielded good results. Improvement was dose-dependent, and was limited by irritability and action tremor when the patient was taking 1,600 mg per day.
