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Banasiak S, Hartel M, Frosch KH, Berger-Groch J. Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches. J Orthop Surg Res 2024; 19:54. [PMID: 38212819 PMCID: PMC10782765 DOI: 10.1186/s13018-023-04525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA ("Direct Anterior Approach with bikini incision") are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes. METHODS This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded. RESULTS For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05). CONCLUSION The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study.
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Affiliation(s)
- Sylwia Banasiak
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Josephine Berger-Groch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Clinic of Trauma and Orthopaedic Surgery, Klinikum Stuttgart, Kriegsbergstr. 60, 70714, Stuttgart, Germany.
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Nakamori M, Toko M, Yamada H, Hayashi Y, Yoshikawa K, Yoshikawa M, Nagasaki T, Hiraoka A, Shimizu Y, Mikami Y, Maruyama H. Impact of neck percutaneous interferential current sensory stimulation on swallowing function in patients with Parkinson's disease: A single-arm, open-label study protocol. Contemp Clin Trials Commun 2023; 33:101158. [PMID: 37342176 PMCID: PMC10277457 DOI: 10.1016/j.conctc.2023.101158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
Background Parkinson's disease (PD) can lead to swallowing dysfunction, resulting in aspiration pneumonia. Among the types of swallowing disorders, a characteristic and serious problem associated with PD is silent aspiration due to pharyngeal and laryngeal hypoesthesia. Methods This single-arm, open-label study aims to evaluate the effectiveness of percutaneous neck interferential current sensory stimulation in enhancing swallowing function in patients with PD. The efficacy and safety of percutaneous neck interferential current sensory stimulation will be investigated for patients diagnosed with PD, based on the Movement Disorder Society criteria, of Hoehn-Yahr stages 2-4. The patients will receive neck percutaneous interferential current sensory stimulation for 20 min twice a week for 8 weeks using a Gentle Stim® (FoodCare Co., Ltd., Kanagawa, Japan) device. Once the intervention is initiated, evaluations will be performed every 4 weeks for a 16-week period. The primary endpoint to be assessed is the proportion of patients with normal cough with 1% citric acid at the end of the intervention (8 weeks after intervention initiation) compared with that at the beginning. This clinical trial will examine the usefulness of percutaneous neck interferential current sensory stimulation in patients with PD. In addition, this study will use novel instruments, such as multichannel surface electromyography and electronic stethoscope, to evaluate swallowing function. Discussion This novel evaluation can provide insights into dysphagia in patients with PD and the usefulness of percutaneous neck interferential current stimulation. This exploratory study is limited by its single-arm, open-label design and small size. Trial registration number jRCTs062220013; pre-results.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Tella BA, Oghumu SN, Gbiri CAO. Efficacy of Transcutaneous Electrical Nerve Stimulation and Interferential Current on Tactile Acuity of Individuals With Nonspecific Chronic Low Back Pain. Neuromodulation 2022; 25:1403-1409. [PMID: 34405486 DOI: 10.1111/ner.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) are pain electrotherapies with questioned efficacy. Studies of their effects on tactile acuity of individuals with nonspecific chronic low back pain (NSCLBP) are limited, hence, this study. MATERIALS AND METHODS Thirty-three individuals with NSCLBP randomly allocated into three groups completed this study. Data collected from participants included age, gender, and anthropometric characteristics of height, weight, body mass index, and percentage body fat measured with standard instruments. Also, participants' tactile acuity, pain intensity, and disability were assessed before and after interventions with digital caliper, numerical pain rating scale, and Roland-Morris Disability Questionnaire, respectively. Interventions consisted of stretching, strengthening, and stabilization exercises to all three groups in addition of TENS to group 1 and IFC to group 2, respectively, for five weeks. Descriptive statistics of mean and standard deviation summarized the data. Inferential statistics of paired t-test, independent t-test, and analysis of variance tested the level of significance among variables at p ≤ 0.05. RESULTS Tactile acuity was significantly (p < 0.05) increased after TENS intervention only, while pain intensity was significantly (p < 0.05) reduced after the three interventions. The result showed no gender difference in tactile acuity values among the participants. CONCLUSIONS TENS increases the tactile acuity of individuals with NSCLBP, whereas IFC demonstrated no significant change in tactile acuity.
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Affiliation(s)
- Bosede Abidemi Tella
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Saturday Nicholas Oghumu
- Department of Physiotherapy, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River, Nigeria.
| | - Caleb Ademola Omuwa Gbiri
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Bavestrello Piccini G, Domont P, Curac S. [Not Available]. LA REVUE DU PRATICIEN 2022; 72:535-538. [PMID: 35899647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Gaia Bavestrello Piccini
- Service des urgences, cliniques universitaires de Bruxelles, hôpital Erasme, Bruxelles, Belgique
| | - Pierre Domont
- Service des urgences, cliniques universitaires de Bruxelles, hôpital Erasme, Bruxelles, Belgique
| | - Sonja Curac
- Service des urgences, cliniques universitaires de Bruxelles, hôpital Erasme, Bruxelles, Belgique
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Benites BM, Miranda-Silva W, Rocha AC, Passos UL, Fonseca FP, da Silva CAR, Fregnani ER. Late recurrence of Burkitt's lymphoma in the jaw: numb chin syndrome as the only symptom. Autops Case Rep 2021; 11:e2020218. [PMID: 34277486 PMCID: PMC8101652 DOI: 10.4322/acr.2020.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022]
Abstract
The Numb Chin Syndrome (NCS) is defined as facial and oral numbness restricted to the mental nerve’s distribution involving the lower lip, skin of the chin, or gingiva of the lower anterior teeth. Hypoesthesia can occur unilaterally or bilaterally. Although this syndrome is rare, its importance is related to the fact that it represents the clinical manifestations of malignant diseases. Breast cancer and non-Hodgkin lymphoma are the most common cause of NCS. The patient, a 58-year-old woman, treated for a Burkitt Lymphoma (BL) nine years ago, described a two-week history of change in sensitivity and pain in the chin region, without relief with the use of analgesics. She had no headache, speech disturbance, dysphagia, visual disturbance, or other neurological symptoms. No surgical intervention has been performed recently. The intraoral examination revealed a healthy oral mucosa and a small area adjacent to the right mental nerve region that was uncomfortable to palpation. No changes were found in the bone trabeculae at cone-beam computed tomography. The contrasted magnetic resonance features made it possible to identify a change in the mandibular body extending to the entire right side, coinciding with the patient’s complaint, indicating a probable mandibular medullary invasion. The patient was submitted to a biopsy to rule out a possible recurrence of BL. The microscopic findings were consistent with the diagnosis of BL. The present report described a very unusual presentation of late recurrent BL nine years after the first treatment, which manifested as an NCS.
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Affiliation(s)
| | | | - André Caroli Rocha
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | | | - Felipe Paiva Fonseca
- Universidade de Minas Gerais (UFMG), Faculdade de Odontologia, Departamento de Patologia Oral, Belo Horizonte, MG, Brasil
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Schulz RE, de Lima MHA, Lopes RN, Pinto CAL, Nicolau UR, Araujo JP. A rare case of Ewing sarcoma metastasis to the oral cavity. Imaging Sci Dent 2021; 51:217-222. [PMID: 34235068 PMCID: PMC8219447 DOI: 10.5624/isd.20200318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022] Open
Abstract
Ewing sarcoma in the head and neck is rare, and metastasis from other bones to the mandible accounts for 0.7% of cases. This report presents a case of oral metastasis in a 24-year-old male patient diagnosed with Ewing sarcoma of the femur (p53 gene mutation and EWSR1-ERG fusion). The chief complaint was numbness in the mandible and pain for 1 month and a hardened, ulcerated exophytic lesion in the right retromolar region. Imaging exams revealed an unspecified thinning of the cortical bone of the inferior alveolar canal in the right mandibular ramus, associated with erosion of the alveolar bone. Histopathological analysis confirmed metastasis of Ewing sarcoma. The patient presented an aggressive disease progression and died 1 month after the oral diagnosis. It is important to recognize the signs and symptoms compatible with rare clinical outcomes, leading to an early diagnosis that can improve patients' quality of life and survival.
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Affiliation(s)
- Riéli Elis Schulz
- Department of Stomatology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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Drouet J, Garmi R, Ambroise B, Chatellier A, Veyssière A, Benateau H. Labiomental sensation after segmental mandibulectomy and inferior alveolar nerve preservation for osteoradionecrosis. J Stomatol Oral Maxillofac Surg 2020; 122:557-560. [PMID: 33096263 DOI: 10.1016/j.jormas.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
Advanced mandibular osteoradionecrosis requires a segmental mandibulectomy with reconstruction using a free fibular flap. The conservation of labiomental sensation by lateralization of the inferior alveolar nerve is unusual during a segmental mandibulectomy. A protocol for the evaluation of labiomental sensation has been created for the clinical follow-up of operated patients. The patients included were patients with mandibular osteoradionecrosis who underwent a segmental mandibulectomy with reconstruction by free fibular flap and whose pre-operative labiomental sensation was preserved. All patients were followed-up by the same examiner and operated on by the same surgeon. The neuro-sensitive examination analyses the different forms of sensation at 1 week and at 12 months postoperatively. Between May 2017 and May 2018, 3 consecutive patients were assessed. The results of the labiomental sensitive evaluation using our evaluation protocol attest to the preservation of labiomental sensation. The operating time was increased by an average of 35 min per surgical procedure. The conservation and re-routing of the inferior alveolar nerve in segmental mandibulectomy with fibula free flap reconstruction in patients with osteoradionecrosis allows for the preservation of labiomental sensation, which improves the quality of life of patients. Our protocol can be used in all surgical procedure that affect sensibility.
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Affiliation(s)
- Julien Drouet
- Maxillofacial Surgery and Plastic Surgery Department, Caen University Hospital, 14000 Caen, France; Maxillofacial Surgery and plastic Surgery Department, Centre François-Baclesse, 14000 Caen, France.
| | - Rachid Garmi
- Maxillofacial Surgery and Plastic Surgery Department, Caen University Hospital, 14000 Caen, France
| | - Béatrice Ambroise
- Maxillofacial Surgery and Plastic Surgery Department, Caen University Hospital, 14000 Caen, France
| | - Anne Chatellier
- Maxillofacial Surgery and Plastic Surgery Department, Caen University Hospital, 14000 Caen, France
| | - Alexis Veyssière
- Maxillofacial Surgery and Plastic Surgery Department, Caen University Hospital, 14000 Caen, France; Caen Faculty of Medicine, University of Caen Basse Normandie, 14032 Caen Cedex 5, France; UNICAEN, EA7451 Equipe BioConnecT, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Hervé Benateau
- Maxillofacial Surgery and Plastic Surgery Department, Caen University Hospital, 14000 Caen, France; Caen Faculty of Medicine, University of Caen Basse Normandie, 14032 Caen Cedex 5, France; UNICAEN, EA7451 Equipe BioConnecT, Avenue de la Côte de Nacre, 14000 Caen, France
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Steele L, Raza MH, Perry R, Rane N, Camp SJ. Subarachnoid haemorrhage due to intracranial vertebral artery dissection presenting with atypical cauda equina syndrome features: case report. BMC Neurol 2019; 19:262. [PMID: 31666024 PMCID: PMC6820950 DOI: 10.1186/s12883-019-1487-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 10/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH. Case presentation A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm. Conclusion We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging.
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Affiliation(s)
- Lloyd Steele
- Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London, W6 8RF, UK.
| | - Muhammad Hasan Raza
- Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London, W6 8RF, UK
| | - Richard Perry
- Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Neil Rane
- Department of Interventional Neuroradiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sophie J Camp
- Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London, W6 8RF, UK
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Abstract
Anxiety is a common yet frequently overlooked psychiatric symptom in patients with ESRD treated with hemodialysis (HD). Anxiety is characterized by disruptive feelings of uncertainty, dread, and fearfulness. A variety of common medical complaints may be manifestations of an anxiety disorder, including palpitations, tremors, indigestion, numbness/tingling, nervousness, shortness of breath, diaphoresis, and fear. It is essential for the clinician to rule out specific medical conditions, including cardiovascular, pulmonary, and neurologic diseases, before ascribing these symptoms to an anxiety disorder. In addition, there is considerable overlap between the symptoms of anxiety and those of depression and uremia. This psychiatric condition has a significant adverse impact on patients' perception of quality of life. Little is known regarding the prevalence and impact of anxiety disorders in patients with ESRD treated with HD; however, many of the seemingly irrational behaviors of patients, or behaviors which place them in conflict with staff and physicians, such as behavioral noncompliance, may be the expression of an underlying anxiety disorder. In this review, we present three clinical vignettes, highlighting the impact of anxiety disorders in patients with ESRD treated with HD.
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Affiliation(s)
- Scott D. Cohen
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC
| | - Daniel Cukor
- Department of Psychiatry and Behavioral Science, State University of New York Downstate Medical Center, Brooklyn, New York; and
| | - Paul L. Kimmel
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Oh D, Yun T, Kim J, Choi J, Jeong W, Chu H, Lee S. The Measurement of the Sensory Recovery Period in Zygoma and Blow-Out Fractures with Neurometer Current Perception Threshold. Arch Plast Surg 2016; 43:411-7. [PMID: 27689047 DOI: 10.5999/aps.2016.43.5.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Facial hypoesthesia is one of the most troublesome complaints in the management of facial bone fractures. However, there is a lack of literature on facial sensory recovery after facial trauma. The purpose of this study was to evaluate the facial sensory recovery period for facial bone fractures using Neurometer. Methods Sixty-three patients who underwent open reduction of zygomatic and blowout fractures between December 2013 and July 2015 were included in the study. The facial sensory status of the patients was repeatedly examined preoperatively and postoperatively by Neurometer current perception threshold (CPT) until the results were normalized. Results Among the 63 subjects, 30 patients had normal Neurometer results preoperatively and postoperatively. According to fracture types, 17 patients with blowout fracture had a median recovery period of 0.25 months. Twelve patients with zygomatic fracture had a median recovery period of 1.00 month. Four patients with both fracture types had a median recovery period of 0.625 months. The median recovery period of all 33 patients was 0.25 months. There was no statistically significant difference in the sensory recovery period between types and subgroups of zygomatic and blowout fractures. In addition, there was no statistically significant difference in the sensory recovery period according to Neurometer results and the patients' own subjective reports. Conclusions Neurometer CPT is effective for evaluating and comparing preoperative and postoperative facial sensory status and evaluating the sensory recovery period in facial bone fracture patients.
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Bova J, Sergent A. Chiropractic management of a 24-year-old woman with idiopathic, intermittent right-sided hemiparesthesia. J Chiropr Med 2014; 13:282-6. [PMID: 25435843 DOI: 10.1016/j.jcm.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the chiropractic management of a patient with idiopathic, intermittent right-sided hemiparesthesia. CLINICAL FEATURES A 24-year-old woman presented with a 2-year history of intermittent idiopathic right arm paresthesia. She also had a 3-month history of intermittent idiopathic right leg/face paresthesia. These symptoms were strongest at night and caused insomnia and worsened over time. She rated her discomfort at 5/10 on a numeric scale. INTERVENTION AND OUTCOME Care included vibration stimulation therapy, spinal manipulation and cold laser therapy. She had a noticeable reduction in her paresthesia both subjectively and objectively. She showed improvement in paresthesia on the right side of her body after the first visit. The following week, after 2 visits she returned and stated that she was symptom free with 0/10 discomfort on a numeric scale. CONCLUSION This patient's symptoms of idiopathic, intermittent right-sided hemi-paresthesia seemed to improve with a short course of chiropractic care using manipulation, vibration therapy and cold laser therapy.
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Affiliation(s)
| | - Adam Sergent
- Assistant Professor, Clinic Services, Palmer Chiropractic College of Florida, Port Orange, FL
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Mok WL, Por YC, Tan BK. Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications. Arch Plast Surg 2014; 41:709-15. [PMID: 25396184 DOI: 10.5999/aps.2014.41.6.709] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/10/2014] [Accepted: 08/20/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. METHODS The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. RESULTS From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. CONCLUSIONS The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.
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Desai NA, Khatri SM, Agarwal AB. Immediate effect of scapular repositioning with active cervical rotation in acute spasmodic torticollis. J Manipulative Physiol Ther 2013; 36:412-7. [PMID: 23850070 DOI: 10.1016/j.jmpt.2013.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 03/03/2013] [Accepted: 03/25/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this preliminary study was to investigate the immediate effects on pain and pressure pain threshold (PPT) of a scapular repositioning technique in patients with acute spasmodic torticollis. METHODS A randomized, single blind pilot study was conducted. The subjects were 23 individuals (age 20-40 years) with a clinical diagnosis of spasmodic torticollis. Visual analog scale pain score, cervical active ranges of motion, and PPT were assessed before and after the intervention. The comparison group was treated with only conventional physiotherapy (microwave diathermy, submaximal isometrics, and ergonomic advice). The intervention group was given scapular repositioning with active cervical rotation technique, in addition to conventional physiotherapy treatment. RESULTS There were significant improvements in intensity of pain (P < .01), cervical rotation to the ipsilateral side (P < .01), cervical side flexion to the contralateral side (P < .01), and PPT (P < .01) immediately after the treatment of the scapular repositioning and conventional therapy compared with the conventional therapy alone. CONCLUSION The present pilot study demonstrated that scapular repositioning may have an immediate hypoalgesic effect on individuals with spasmodic torticollis in terms of pain severity, PPT, and cervical range of motion. Therefore, further controlled trials are warranted.
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Affiliation(s)
- Niyati A Desai
- Clinical Physical Therapist, Pravara Institute of Medical Sciences, Loni, Maharashtra State, 413 736 India.
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Abstract
Atrial myxomas are the most common benign primary tumor of the heart. These cardiac growths can masquerade as mitral stenosis and infective endocarditis. A 35-year-old man presented with complaints of nonspecific symptoms. Echocardiogram revealed a large atrial myxoma occupying the left atrium. Excision revealed a 14 × 8 × 6 cm3 tumor attached to a 4 × 3 × 2 cm3 stalk of septal tissue. We describe a giant left atrial myxoma. We were not able to find another myxoma as big as this one in the literature, so we are reporting it.
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