scholarly journals Salvage of Necrotic-Appearing Limb after In Utero Endoscopic Lysis of Constriction Bands

2017 ◽  
Vol 07 (02) ◽  
pp. e74-e78 ◽  
Author(s):  
A. Chon ◽  
B. Chen ◽  
W. Burkhalter ◽  
R.H. Chmait ◽  
M. Abdel-Sattar
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Color Doppler ◽  
Lower Extremities ◽  
In Utero ◽  
Postnatal Life ◽  
Amniotic Band ◽  
Constriction Band ◽  
The Right ◽  
And Function

AbstractWe report a case of amniotic band syndrome complicated by constriction bands and marked distal swelling of both lower extremities. Color Doppler interrogation of the right lower extremity revealed complete lack of blood flow below the level of the constriction. Upon fetoscopic survey, the right lower extremity beyond the constriction band appeared dusky red and discolored with desquamation, consistent with a necrotic appearance. The constriction bands were cut in utero using endoshears, thereby allowing restoration of blood flow on postoperative day 1. The patient was counseled extensively regarding the possibility of limb dysfunction or amputation. However, the baby was born with functional lower extremities, and at 21 months of age, the child was cruising and jumping on his own. This case demonstrates that there is unique plasticity in fetal limb recovery after a severe ischemic injury that is not otherwise seen in postnatal life. Reperfusion of the necrotic-appearing limb resulted in restoration of appearance and function without apparent deleterious effects on the fetus. We believe the favorable outcome in this case was likely due to timeliness of the in utero lysis of amniotic bands and the plasticity of fetal healing.

scholarly journals A Case of Ovarian Torsion Which Led to Abortion

2021 ◽  
Author(s):  
Athar Rasekhjahromi ◽  
Sahand Goodarzi ◽  
Navid Kalani
Keyword(s):  
Blood Flow ◽  
Abdominal Pain ◽  
Color Doppler ◽  
Ovarian Torsion ◽  
Simultaneous Occurrence ◽  
Pelvic Ultrasound ◽  
Triplet Pregnancy ◽  
Vaginal Pain ◽  
History Of ◽  
The Right

Ovarian torsion occurs in 10%-22% of pregnant women, and miscarriage occurs in 11%-22% of all pregnancies, both of which are known as gynecological emergencies. The simultaneous occurrence of these two cases is rare. The present study reports a case of ovarian torsion and simultaneous abortion. In this case report, we present a 28-year-old woman in her third pregnancy with a history of two miscarriages. She was referred with an 18-week triplet pregnancy, vaginal pain and bleeding from the previous day, and colic abdominal pain with five episodes of nausea and vomiting. Upon admission to the hospital, despite performing cerclage at 13 weeks, labor pains begin, and 15 minutes later, the amniotic sac ruptures, and all three fetuses are expelled. Due to the persistence of colic pain and moderate tenderness in the lower right quadrant of the abdomen, pelvic ultrasound is reported, which shows an increase in echo parenchyma and the size of the right ovary compared to the left ovary. Doppler ultrasound showed decreased ovarian blood flow, which led to laparotomy with suspected ovarian torsion. The right ovarian peduncle had complete torsion, and the ovary appeared dark. The peduncle of ovarian torsion was opened and preserved. The patient was discharged two days after surgery and after re-color Doppler ultrasounds, which indicated ovarian blood flow.

Non Invasive Measurement of Blood Flow in the Human Lower Extremity

2007 ◽  
Author(s):  
Hehe Zhou ◽  
John E. Novotny ◽  
Liyun Wang
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Stress Fracture ◽  
Financial Burden ◽  
Lower Extremities ◽  
Focal Ischemia ◽  
Stress Fractures ◽  
Diagnostic Tools ◽  
Blood Flows ◽  
Non Invasive

Stress fracture in lower extremities occurs commonly among military recruits and athletes during intensive physical training. This injury has a marked impact on the health of military personnel and imposes a significant financial burden [1]. Despites advances in stress fracture studies, its pathogeneses remains poorly understood and early diagnostic tools are lacking. Focal ischemia is a potential initiator of site-specific bone remodeling and may cause stress fractures in human lower extremity [2, 3]. We hypothesize that intensive repetitive loading impairs intramedullary blood flow due to pressurization of the bone marrow cavity, leading to focal ischemia and eventual development of stress fractures. To begin to test our hypothesis, we developed and validated a quantitative, non-invasive method to measure blood flow in vivo. The approach was based on Cine Phase Contrast MRI (CPC-MRI), a dynamic motion measurement and visualization modality that was originally designed for cardiovascular studies. By measuring the phase shift that is induced by pulsatile blood flows in the magnetic resonance signal, cross-sectional images and velocity maps are acquired of the moving fluid. This technique has been adapted to study blood flows in skeletal muscles [4], intracranial flows [5], and muscle mechanics and joint kinematics [6]]. We first performed a flow phantom study to validate the reliability and accuracy of CPC-MRI in measuring flow velocity. We then quantified the effects of brief exercise on blood flows in the lower extremities of human subjects. These non-invasive measurements will help us better understand the interplay between vasculature and skeletal system in various physiological and pathological conditions.

scholarly journals Organ-preserving operation in case of massive testicular rupture

2019 ◽  
Vol 20 (4) ◽  
pp. 52-58
Author(s):  
T. Kh. Nazarov ◽  
I. V. Rychkov ◽  
K. E. Trubnikova ◽  
A. S. Lepekhina ◽  
Kh. U. Khaknazarov
Keyword(s):  
Blood Flow ◽  
Clinical Case ◽  
Clinical Observation ◽  
Color Doppler ◽  
Traumatic Injury ◽  
Blunt Injury ◽  
Hormonal Status ◽  
Lower Pole ◽  
Testicular Rupture ◽  
The Right

The objective is to present a clinical case of blunt trauma of the scrotum with a massive testicular crush. The presented nosology, methods of diagnosis and surgical treatment is highlighted.Clinical case. Patient, 18 years old, was admitted to the clinic with acute symptoms and complaints of pain and increased size of the right part of the scrotum. Questioning revealed that 48 hours prior the patient received a blunt injury of the scrotum. Ultrasound of the scrotal organs showed that in the right part of the scrotum testicle is not clearly differentiated, in the lower pole hypoechogenic signal is observed, no blood flow was evident using the color Doppler mode, but examination of the upper pole showed weak blood flow, the epididymis was partially differentiated. Hematocele was observed. The diagnosis of injury of the scrotal organs was confirmed, traumatic injury of the right testicle. Emergency surgery was performed: necrotized areas of the lower pole of the testicle were resected, plastic sealing of the upper pole of the right testicle to the epididymis was performed. Postoperative period was free of complications. The patient was discharged on day 6 after the surgery. Control ultrasound after 3 months showed that the right testicle was smaller, its echostructure was homogenous, blood flow in the testicular parenchyma was observed. Hormonal status, blood testosterone levels, ejaculate parameters were normal.Conclusion. The presented clinical observation confirms that organ-sparing interventions for massive crush injury of the testicle with minimal volume of viable tissue are possible but patient’s age and time after injury should be taken into account.

Color Doppler Ultrasound Evaluation of Internal Jugular Vein Before Radical Neck Dissection

2019 ◽  
Vol 9 (2) ◽  
pp. 371-375
Author(s):  
Zhiyong Chen ◽  
Binshan Zha ◽  
Yan Li ◽  
Yongchao Chen
Keyword(s):  
Blood Flow ◽  
Neck Dissection ◽  
Color Doppler ◽  
Radical Neck Dissection ◽  
Venous Drainage ◽  
Color Doppler Ultrasound ◽  
Sitting Position ◽  
Section Area ◽  
Cerebral Venous Drainage ◽  
The Right

Objective: There is a great controversy about whether the internal jugular vein (IJV) should be retained during radical neck dissection. In this study, the right and left IJV under different body position were observed by color Doppler ultrasound, in order to provide a experimental basis for the preservation of IJV in neck dissections. Methods: A total of 40 patients with thyroid cancer undergoing radical neck dissection were examined in this study. The hemodynamic data such as section area, velocity, and volume of blood flow were measured by Doppler in supine and sitting position under quiet breath. Results: In supine position, the cross sectional area, the velocity and the blood flow volume in the right side were 58%, 23% and 91% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 65%, 25%, and 10% of patients. The blood flow of bilateral IJV was 74% of total cerebral outflow. The IJV predominate, balanced type, and no-IJV predominate cerebral venous drainage was in 73%, 23% and 5% of patients. In sitting position, the section area, the velocity and the blood flow volume in the right side were 29%, 35% and 56% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 45%, 45%, and 10% of patients. The blood flow of bilateral IJV was 23% of total cerebral outflow. The balanced type and no-IJV predominate cerebral venous drainage was in 23% and 78% of patients. Conclusions: There are side advantage of IJV. With quiet breathing, IJV is not the main pathway of cerebral venous drainage in sitting position. The preoperative ultrasound is useful to design the individualized surgical approach for the radical neck dissections.

scholarly journals Amniotic constriction band syndrome resulting in amputation caused by septate uterus: a case report

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052094975
Author(s):  
Tian He ◽  
Hao Xu ◽  
Ping Sui ◽  
Xin Wang ◽  
Yujie Sun
Keyword(s):  
Clinical Evidence ◽  
Tissue Necrosis ◽  
Septate Uterus ◽  
Amniotic Band ◽  
Amniotic Band Syndrome ◽  
Constriction Band ◽  
Congenital Condition ◽  
Uterine Septum ◽  
The Right ◽  
Constriction Band Syndrome

Amniotic band syndrome is an unusual congenital condition characterized by manifestations of disfigurement and disablement. Patients with this condition may experience an array of clinical deformities, including constriction rings, digital defects, and even visceral defects. Although this disease has been identified for centuries, its etiology is still unknown. The present male patient was born by cesarean section at 34 weeks and 4 days of gestation. At birth, an amniotic band that encircled and constricted his right upper limb was observed. Four hours after the amniotic band was cut off, amputation was performed because the right limb remained insensate. The patient suffered from amniotic band syndrome and presented with a gangrenous limb leading to amputation at birth, which is extremely rare. Moreover, the patient’s mother suffered from a uterine septum, which has not been previously reported in this situation. Timely surgical treatment avoided further tissue necrosis threating the patient’s life. This rare case of amniotic band syndrome provides new clinical evidence for the “extrinsic theory”.

Reliability of Lower Extremity Girth Measurements and Right- and Left-Side Differences

1995 ◽  
Vol 4 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Susan L. Whitney ◽  
Larry Mattocks ◽  
James J. Irrgang ◽  
Pamela A. Gentile ◽  
David Pezzullo ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Physical Therapists ◽  
Lower Extremities ◽  
Tape Measure ◽  
The Right

The purpose of this two-part study was to determine if lower extremity girth measurements are repeatable. Sixteen males and 14 females participated in the intra- and intertester reliability portion of this study. Girth was assessed at five different lower extremity sites by two physical therapists using a standard tape measure. Thirty measures (15 by each examiner) were collected on the subject's right leg, and a mean of the three measures was used in the analysis. The measurements were repeated 7 days later. It was found that by using a simple standardized procedure, girth measurements in the clinic can be highly repeatable in experienced clinicians. Part 2 of the study involved testing the right and left legs of 22 subjects to determine if girth of the right and left legs was similar. All subjects had their girth assessed at five sites on their right and left legs during one session. It was found that girth measures on the right and left lower extremities are comparable. In an acutely injured lower extremity, it might be assumed that the girth of both lower extremities is similar.

scholarly journals The Proximal and Distal Effects of Blood Flow Restriction Therapy on Upper and Lower Extremity Strengthening: A Randomized Controlled Trial

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Eric N. Bowman ◽  
Rami El-shaar ◽  
Heather Milligan ◽  
Greg Jue ◽  
Karen Mohr ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Blood Flow ◽  
Lower Extremity ◽  
Controlled Trial ◽  
Lower Extremities ◽  
Blood Flow Restriction ◽  
Control Group ◽  
Flow Restriction ◽  
Low Intensity ◽  
Randomized Controlled

Objectives: Blood flow restriction (BFR) therapy consists of low-intensity exercise performed under reduced venous return due to an inflatable tourniquet. This produces similar physiologic and clinical effects to high-intensity routines with less joint and tissue stress. Postoperative patients may benefit from more efficient rehabilitation. Proximal and distal effects of BFR have been evaluated, however, minimal literature exists on its use in orthopaedic conditions. The purpose of this study was to determine the effects of low-intensity BFR therapy both proximal and distal, in the upper and lower extremities. Methods: This was a prospective, randomized controlled trial of healthy subjects completing a standardized 6-week course of BFR therapy. Subjects were randomized to BFR therapy on one extremity or to a control group. Subjects were excluded for cardiac, pulmonary, or hematologic disease, pregnancy, or previous surgery in the extremity. Data collected at baseline and completion included: limb circumferences, isokinetic, and manual strength testing. Results: Forty subjects completed the protocol. Average age was 27.7 years; 54% were female. For both upper and lower extremity groups, a statistically significant increase was observed in manual and isokinetic strength both proximal and distal to the BFR tourniquet when compared to both the non-tourniquet extremity and the control group (p<0.05). Limb circumference significantly increased in the upper (p<0.01) and lower extremities (p=0.02). A significant increase in manual strength was noted in shoulder abduction and scaption, and hip extension and abduction even in the non-tourniquet BFR extremity compared to the control group (p<0.05). Conclusion: Low-intensity BFR therapy led to greater increases in muscle strength and hypertrophy. Similar strengthening effects were seen in proximal and distal muscle groups. Strength increases in the contralateral BFR extremity may corroborate a systemic effect. This study provides data to further evaluate the efficacy and safety of BFR therapy in operative and non-operative orthopaedic conditions. [Table: see text]

scholarly journals Giant congenital nodular melanoma in a newborn: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Zhou ◽  
Meng-xing Lv ◽  
Ling Duan ◽  
Yu-cheng Xie ◽  
Zhi-xiang A ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Surgical Resection ◽  
Doppler Ultrasound ◽  
Color Doppler ◽  
Surgical Excision ◽  
Color Doppler Ultrasound ◽  
In Utero ◽  
Braf V600e ◽  
Pathological Examination ◽  
The Right

Abstract Background Malignant melanoma (MM) arises predominantly after adolescence and is uncommon in children. Congenital MM in newborns is even rarer with a dearth of published literature; as a consequence, there is no uniform standard for the pathogenesis and treatment for neonatal malignant melanoma. Herein we report a case of giant congenital nodular MM in a newborn, including its clinical, imaging, pathological and molecular pathological features. This case is the largest giant congenital primary nodular malignant melanoma in utero in neonates currently reported in China. Case presentation A female neonatal patient was found to have a 2.97 cm× 1.82 cm×1.50 cm mass with a clear boundary at the right acromion in color Doppler ultrasound examination at 24 weeks of gestation. The mass increased to 3.0 cm×5.0 cm×9.0 cm at birth, and local ulceration was seen. MRI demonstrated that the mass was located on the right shoulder and underarm in a lobulated appearance, and surrounded the right scapula which was deformed. Clinical stage:IV(AJCC 8th Edition (2017)). α-Fetoprofein (AFP) by hematological examination: 1210ng/ml, NSE: 21.28ng/ml, LDH: 842U/L. The patient underwent surgical resection of the tumor, and was pathologically diagnosed as neonatal congenital malignant melanoma; immunohistochemistry (IHC): S-100 (+), HMB45 (+), Melan A (+), and Tyrosinase (+). Molecular pathological examination for BRAF V600E showed no mutations (Quantitative Real-time PCR, qPCR); And so were NRAS, C-kit (exons 9,11,13,14,17,18), and TERT (promoter locus, C228T and C250T) (Sanger sequencing). Non-surgical therapies were not carried out after the surgical resection of the tumor. After 6 months of follow-up, the child developed normally, and color Doppler ultrasound showed no obvious tumor growth or abnormality in the original tumor site. Conclusions It is extremely rare to see giant congenital primary nodular MM in utero in neonates. The pathogenesis, treatment and prognosis of congenital MM need further research. The diagnosis mainly depends on histopathology and immunohistochemistry, and it needs to be differentiated from malignant lymphoma and primitive neuroectodermal tumor. The current treatment strategy for MM relies on the surgical excision of the mass. Research directed at molecular detection for genetic mutations would contribute to targeted therapy and better prognosis.

scholarly journals Discrepancies in Prevalence of Peripheral Arterial Disease between Lower Extremities at Rest and Postexercise

2017 ◽  
Vol 26 (03) ◽  
pp. 179-185 ◽  
Author(s):  
Kevin Cohoon ◽  
Guillaume Mahe ◽  
David Liedl ◽  
Thom Rooke ◽  
Paul Wennberg
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Medical Condition ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Left Lower Extremity ◽  
Pressure Decrease ◽  
Exercise Treadmill ◽  
Peripheral Arterial ◽  
The Right

Background Lower extremity peripheral arterial disease (PAD) is a common medical condition causing substantial morbidity. Limited data exist on whether discrepancies in PAD prevalence exist between the lower extremities using resting ankle-brachial indices (ABIs) and postexercise pressures. Objective We predicted the prevalence of PAD between the lower extremities. Methods and Results Consecutive patients who had undergone a noninvasive arterial lower extremity study at Mayo Clinic, Rochester, MN, between January 1996 and December 2012 with suspected PAD were retrospectively reviewed. We identified 12,312 consecutive patients who underwent an arterial lower extremity and an exercise treadmill study. Prevalence of PAD was assessed at rest and after exercise using two criteria: a resting ABI ≤ 0.90 and a postexercise pressure decrease of > 30 mm Hg. Mean age was 67 ± 12 years and there were 4,780 (39%) women studied. At rest, we found a higher prevalence of PAD on the left extremity (27.4%) compared with the right (24.6%) (p < 0.0001). After exercise, we found a higher prevalence of PAD on the right extremity (25.1%) compared with the left (19.0%) (p < 0.0001). These discrepancies between the prevalence of PAD at rest and after exercise were present in women and men. Conclusion Using validated criteria of a resting ABI of ≤ 0.90 and postexercise ankle pressure decrease > 30 mm Hg, our results suggest that there is a significantly higher prevalence of PAD in the left lower extremity at rest, in contrast to a greater prevalence of abnormal postexercise testing in the right lower extremity. The reason(s) of these discrepancies remain to be studied.

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