scholarly journals Lower-limb rigidity is associated with frequent falls in Parkinson disease

2019 ◽  
Author(s):  
J. Lucas McKay ◽  
Madeleine. E. Hackney ◽  
Stewart A. Factor ◽  
Lena H. Ting
Keyword(s):  
Parkinson Disease ◽  
Lower Limb ◽  
Disease Duration ◽  
Lower Leg ◽  
Veterans Affairs ◽  
Muscle Rigidity ◽  
Department Of Veterans Affairs ◽  
History Of ◽  
Financial Disclosures

AbstractBACKGROUND AND OBJECTIVE:The role of muscle rigidity as an etiological factor of falls in Parkinson disease (PD) is poorly understood. Our objective was to determine whether lower leg rigidity was differentially associated with frequent falls in PD compared to upper limb, neck, and total rigidity measures. METHODS: We examined associations between UPDRS-III (motor) rigidity subscores and history of monthly or more frequent falls in N=216 individuals with PD (age, 66±10 y; 36% female, disease duration, 7±5 y) with logistic regression. RESULTS: N=35 individuals were frequent fallers. Significant associations were identified between lower limb rigidity and frequent falls (P=0.01) after controlling for age, sex, PD duration, total UPDRS-III score, and presence of FOG. No significant associations (P≥0.14) were identified for total, arm, or neck rigidity. CONCLUSION: Lower limb rigidity is related to frequent falls in people with PD. Further investigation may be warranted into how parkinsonian rigidity could cause falls.Financial Disclosures/Conflict of Interest concerning the research related to the manuscript: NoneFunding:NIH K25HD086276, R01HD046922, R21HD075612, UL1TR002378, UL1TR000454; Department of Veterans Affairs R&D Service Career Development Awards E7108M and N0870W, Consolidated Anti-Aging Foundation, and the Sartain Lanier Family Foundation.

Arteries masquerading as varicose veins: A trap for phlebologists

2014 ◽  
Vol 30 (10) ◽  
pp. 729-735 ◽  
Author(s):  
L Jones ◽  
K Parsi
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Tissue Loss ◽  
Injection Sclerotherapy ◽  
Ultrasound Guided ◽  
History Of ◽  
The Right

Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein “stripping”, presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of “stripping”, the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

The management of embedded metal fragment patients and the role of chelation Therapy: A workshop of the Department of Veterans Affairs—Walter Reed National Medical Center

2020 ◽  
Vol 63 (5) ◽  
pp. 381-393
Author(s):  
Joanna M. Gaitens ◽  
Benjamin K. Potter ◽  
Jean‐Claude G. D'Alleyrand ◽  
Archie L. Overmann ◽  
Michael Gochfeld ◽  
...  
Keyword(s):  
Chelation Therapy ◽  
Medical Center ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
National Medical ◽  
Metal Fragment

scholarly journals Progressive encephalomyelitis with rigidity: a paraneoplastic presentation of oat cell carcinoma of the lung. Case report

2004 ◽  
Vol 62 (2b) ◽  
pp. 547-549 ◽  
Author(s):  
Mariana Spitz ◽  
Henrique Ballalai Ferraz ◽  
Orlando G. P. Barsottini ◽  
Alberto Alain Gabbai
Keyword(s):  
Spinal Cord ◽  
Cell Carcinoma ◽  
Lower Limb ◽  
Cranial Nerves ◽  
Muscle Rigidity ◽  
Left Lower Limb ◽  
History Of ◽  
Brain Ct Scan ◽  
Spinal Mri ◽  
Oat Cell Carcinoma

Progressive encephalomyelitis with rigidity and myoclonus (PEWR) is a rare neurological disorder, characterised by muscular rigidity, painful spasms, myoclonus, and evidence of brain stem and spinal cord involvement. A 73-year-old white man was admitted with a 10-day history of painful muscle spasms and continuous muscle rigidity on his left lower limb. He had involuntary spasms on his legs and developed encephalopathy with cranial nerves signs and long tract spinal cord symptomatology. Brain CT scan and spinal MRI were normal. The CSF showed lymphocytic pleocytosis and no other abnormalities. EMG showed involuntary muscle activity with 2-6 seconds of duration, interval of 30-50 ms and a frequency of 2/second in the left lower limb. Anti-GAD antibodies were detected in the blood. We detected radiological signs of lung cancer during the follow-up, which proved to be an oat cell carcinoma. The patient died two weeks after the diagnosis of the cancer.

scholarly journals Reversals in initially denied Department of Veterans Affairs’ PTSD disability claims after 17 years: a cohort study of gender differences

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maureen Murdoch ◽  
Michele Roxanne Spoont ◽  
Nina Aileen Sayer ◽  
Shannon Marie Kehle-Forbes ◽  
Siamak Noorbaloochi
Keyword(s):  
Gender Differences ◽  
Sexual Assault ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Process Improvements ◽  
Military Sexual Assault ◽  
History Of ◽  
Nationally Representative ◽  
Disability Rating ◽  
Gender Discrepancies

Abstract Background In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims’ outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims’ outcomes after 2011, determine whether disability awards (also known as “service connection”) for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. Methods From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans’ benefits. Results 51.4% of men and 31.3% of women were service connected for PTSD by study’s end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection—i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study’s end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men’s mean total disability rating was substantially greater than women’s (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men’s versus women’s odds of PTSD service connection. Conclusion Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women’s lower rate of PTSD service connection, but, ultimately, men’s total disability ratings exceeded women’s. Gender discrepancies in service connection should be monitored beyond the initial claims period.

scholarly journals The Role of Sensor Based Insole as a Rehabilitation Tool in Improving Walking among the Patients with Lower Limb Arthroplasty: A Protocol for Systematic Review

2020 ◽  
pp. 22-27
Author(s):  
Sumit Raghav ◽  
Anshika Singh ◽  
Suresh Mani ◽  
Gokulakannan Kandasamy ◽  
Amber Anand
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
Gait Parameters ◽  
Black Scale ◽  
History Of ◽  
Review Protocol ◽  
Human Participants ◽  
Rule Out ◽  
The Ideal

Objectives: The purpose of this review protocol is to assess the role of sensor based insole in improving walking in patients with lower limb arthroplasty and to rule out the demand and advantage of sensor based insole in utilizing such types of problems at clinical setup. Methodology: A systematic review will be conducted by two independent reviewers who will search articles using electronic search for publications in seven databases: Google Scholar, Index Copernicus, JSTOR, PubMed/Medline, Science Direct, Scopus and Web of Science. After applying the selection criteria, study papers published between the years 2001 to 2019 will be selected. Studies of human participants of 45-75 years of age having history of lower limb arthroplasty will be eligible. All the study papers will be analyzed using Modified Downs and Black scale and scores will be awarded for the items selected on a 27 point scale. Findings: The findings of this review will be disseminated through presentations and peer-reviewed publication. The systematic review will direct the attention of the physiotherapists to assess and evaluate the patient’s walking pattern, as alterations in the biomechanics of joints of lower limb can produce far-reaching effects in the ideal or normal gait. The results of this review will provide evidence regarding changes in gait parameters in patients with lower limb arthroplasty and this information will be useful in planning for rehabilitation in improving walking of patients after lower limb arthroplasty. Novelty: Many studies have been carried on sensor insole technology for monitoring gait. However, there is scarcity of literature based on the systematic reviews on the use of smart sensor insole in improving walking among patients with lower limb arthroplasty.

Patients with schizophrenia and breast cancer: Adjuvant radiation treatment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17506-e17506
Author(s):  
Lauren Davies ◽  
Kashif Abdullah ◽  
Radhakrishna Janardhan ◽  
Mark Hwang ◽  
Michael Farasatpour ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Radiation Treatment ◽  
Care Delivery ◽  
Veterans Affairs ◽  
Tnm Stage ◽  
Patient Treatment ◽  
Adjuvant Radiation ◽  
Department Of Veterans Affairs ◽  
Medical Centers ◽  
History Of

e17506 Background: Schizophrenia affects about 1% of subjects in all populations studied so far. It impairs medical care delivery. We sought to evaluate how patients with schizophrenia who are later diagnosed with breast carcinoma fare when adjuvant radiation therapy (ART) is indicated. Methods: We searched the Patient Treatment File (PTF) of the Department of Veterans Affairs (DVA) to identify subjects with schizophrenia who later developed breast carcinoma and were treated in DVA Medical Centers (DVAMCs) from 1999 - 2005. Chart-based clinical data from the DVAMCs where the subjects had been treated supplemented PTF data. Results: 42 patients had preexisting schizophrenia, later developed breast carcinoma, and were candidates for ART. There were 31 women (74%) and 11 men (26%). 27 of the 42 study subjects had records specifying TNM stage; 18 of the 27 (67%) had TNM stages III-IV. 31 subjects had records about compliance with indicated medical therapies; 24 (77%) had previously been non-compliant. 39 subjects had records regarding therapy delay; 20 (51%) had previously delayed medically indicated therapy. Of the 42 subjects who were candidates for ART based on TNM stage, we found data about the decision to recommend ART in 37; only 23 (26%) were offered ART and 3 of those 23 (26%) refused it. Of the 6 subjects who refused ART, 4 had been non-compliant with previous medically indicated care, 3 had delayed initial cancer treatment, 4 had documented suicidal ideation, and 2 had documented homicidal ideation before being offered ART. Conclusions: Subjects with schizophrenia and breast carcinoma often do not understand their illnesses well. They often do not comply with recommended standard therapies such as ART. Treatments that rely on ART are likely to be met with non-compliance. A history of non-compliance appears to be a predictor of non-compliance with ART. Our results should be of interest to caregivers because we describe ways to avoid suboptimal ART in patients with breast carcinoma. Breast-conserving multi-modality treatment with ART is frequently not appropriate; radical surgery is often preferable.

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