scholarly journals Successful Management of Pregnancy Complicated by Klippel-Trenaunay Syndrome Using MR Angiography-Based Evaluation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Reiko Tanaka ◽  
Yasuyuki Fujita ◽  
Kana Ishibashi Hiasa ◽  
Yasuo Yumoto ◽  
Nobuhiro Hidaka ◽  
...  

Klippel-Trenaunay syndrome (KTS) is a rare congenital disease, and extensive cutaneous hemangiomas and abnormal venous vessels are characteristic. In our case, to manage her pregnancy with KTS, whole-body MRA was performed before delivery. A 29-year-old woman was referred at 28 weeks because of prominent vulvovaginal varicosities due to KTS. At 35 weeks, hypertrophy and multiple venous varicosities of her leg as well as massive vulvovaginal varicosities became prominent with a normal coagulation profile. Systematic MRAs revealed hemangiomas and varicosities in the right leg, the lower abdomen, and the pubic region, while no obvious AVM was detected around the bronchial tube and spine. We decided to deliver her baby by cesarean section at 37 weeks under general anesthesia, and a healthy baby was delivered. No blood transfusion was required. Prophylaxis against thrombosis was performed after the operation. She was discharged with her baby. Her vulvovaginal varicosities shrunk considerably one month later.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sung Eun Kim ◽  
Jangyun Lee ◽  
Sae Yong Lee ◽  
Hae-Dong Lee ◽  
Jae Kun Shim ◽  
...  

AbstractThe purpose of this study was to investigate how the ball position along the mediolateral (M-L) direction of a golfer causes a chain effect in the ground reaction force, body segment and joint angles, and whole-body centre of mass during the golf swing. Twenty professional golfers were asked to complete five straight shots for each 5 different ball positions along M-L: 4.27 cm (ball diameter), 2.14 cm (ball radius), 0 cm (reference position at preferred ball position), – 2.14 cm, and – 4.27 cm, while their ground reaction force and body segment motions were captured. The dependant variables were calculated at 14 swing events from address to impact, and the differences between the ball positions were evaluated using Statistical Parametric Mapping. The left-sided ball positions at address showed a greater weight distribution on the left foot with a more open shoulder angle compared to the reference ball position, whereas the trend was reversed for the right-sided ball positions. These trends disappeared during the backswing and reappeared during the downswing. The whole-body centre of mass was also located towards the target for the left-sided ball positions throughout the golf swing compared to the reference ball position, whereas the trend was reversed for the right-sided ball positions. We have concluded that initial ball position at address can cause a series of chain effects throughout the golf swing.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eiki Mizutani ◽  
Riichiro Morita ◽  
Keiko Abe ◽  
Makoto Kodama ◽  
Shogo Kasai ◽  
...  

Abstract Background Epithelioid sarcoma most frequently occurs in the dermal or subcutaneous area of the distal extremities. To date, there have been three cases of primary pulmonary epithelioid sarcoma reported. We report a case of epithelioid sarcoma that is considered a primary lung tumor. Case presentation A 65-year-old asymptomatic Asian male patient underwent chest radiography during a routine health examination, and an abnormal mass was detected. His past medical history was unremarkable. He smoked 40 cigarettes every day and had slightly obstructive impairment on spirometry. He worked as an employee of a company and had no history of asbestos exposure. He underwent partial resection of the right lung by thoracoscopy. A histological examination of the tumor revealed a cellular nodule of epithelioid and spindle-shaped cells. Some of the tumor cells displayed rhabdoid features and reticular arrangement in a myxomatous stroma. Immunohistochemically, the tumor cells were positive for vimentin, smooth muscle actin (SMA), CD34, and epithelial membrane antigen (EMA); loss of the BAF47/INI1 protein in the tumor cells was also confirmed. A diagnosis of epithelioid sarcoma was established. Careful screening by whole-body positron emission tomography for another primary lesion after surgery did not detect any possible lesion. He had no cutaneous disease. Conclusion To our knowledge, this is the fourth case of a proximal-type epithelioid sarcoma considered as a primary lung tumor.


Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jyoti Bakshi ◽  
Clare Batten

Abstract Background/Aims  A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods  The case is discussed below. Results  Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion  Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure  J. Bakshi: None. C. Batten: None.


2009 ◽  
Vol 24 (5) ◽  
pp. 275-281 ◽  
Author(s):  
Teresa Rodriguez-Cano ◽  
Luis Beato-Fernandez ◽  
Inmaculada Garcia-Vilches ◽  
Ana Garcia-Vicente ◽  
Victor Poblete-Garcia ◽  
...  

AbstractObjectiveThe aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.MethodsThree single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.ResultsFollowing the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.DiscussionMore specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.


2014 ◽  
Vol 14 (06) ◽  
pp. 1440003
Author(s):  
KAP-SOO HAN ◽  
CHANG HO YU ◽  
MYOUNG-HWAN KO ◽  
TAE KYU KWON

The objective of the study was to investigate the effects of 3D stabilization exercises using a whole body tilt device on forces in the trunk, such as individual muscle forces and activation patterns, maximum muscle activities and spine loads. For this sake, a musculoskeletal (MS) model of the whole body was developed, and an inverse dynamics analysis was performed to predict the forces on the spine. An EMG measurement experiment was conducted to validate the muscle forces and activation patterns. The MS model was rotated and tilted in eight different directions: anterior (A), posterior (P), anterior right (AR), posterior right (PR), anterior left (AL), posterior left (PL), right (R) and left (L), replicating the directions of the 3D spine balance exercise device, as performed in the experiment. The anterior directions of the tilt primarily induced the activation of long and superficial back muscles and the posterior directions activated the front muscles. However, deep muscles, such as short muscles and multifidi, were activated in all directions of the tilt. The resultant joint forces in the right and left directions of the tilt were the least among the directions, but higher muscle activations and more diverse muscle recruitments than other positions were observed. Therefore, these directions of tilt may be suitable for the elderly and rehabilitation patients who require muscle strengthening with less spinal loads. In the present investigation, it was shown that 3D stabilization exercises could provide considerable muscle exercise effects with a minimum perturbation of structure. The results of this study can be used to provide safety guidelines for muscle exercises using this type of tilting device. Therefore, the proposed direction of tilt can be used to strengthen targeted muscles, depending on the patients' muscular condition.


Author(s):  
Almalki Yassir

Abstract Background Leydig cell tumors (LCTs) represent the most common form of stromal tumors. We reported the 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings of a patient with testicular LCT. Case presentation A 50-year-old man with a history of end-stage renal disease and renal transplantation 19 years ago. One year earlier, he started to have a chronic rejection. During the investigation to determine the cause of chronic rejection, a suspicious lesion in the graft with a collection around it was seen on ultrasound (US) images, raising the possibility of post-transplant lymphoproliferative disorder (PTLD). The patient was referred for further evaluation by whole body 18F-FDG PET/CT imaging. The image finding revealed an incidental hypermetabolic focal lesion in the right testicle—no other specific findings in the remaining parts of the body nor definitive FDG avid lymphadenopathy to suggest PTLD. Testicular US was requested and showed a well-defined right-sided heterogeneous hypoechoic intratesticular focal mass at the upper pole of the right testis with significant internal vascularity on the color Doppler imaging. The patient underwent a right radical orchidectomy, and the tumor was pathologically confirmed as an LCT. Conclusion In our case, 18F-FDG-PET/CT has been helpful in incidentally detecting this rare testicular tumor in a patient with suspected PTLD.


2021 ◽  
Vol 23 (5) ◽  
pp. 375-380
Author(s):  
Maurizio De Pellegrin ◽  
Désirée Moharamzadeh ◽  
Giacomo Placella ◽  
Vincenzo Salini

Klippel-Trenaunay syndrome is a rare congenital malformation which may be associated with macrodactyly. The main problem is the need for custom-made shoes. We describe the case of a female newborn affected by Klippel-Trenaunay syndrome, with a larger and longer right foot; the difference increased progressively and, at 5 years of age, the right foot was 50% larger and 38% longer than the left one. Due to the progression of the deformity, reduction surgery was advised to reduce the foot’s width. Resection of the second ray and 2nd cuneiform was performed. The result was excellent and there were no complications during a 10-year follow-up period with a decrease of width and length difference to 10% and 4%, respectively, in comparison to the contralateral foot. There were no gait anomalies. Abnormal foot width and length represented the main problems and guided the surgical strategy. Second ray resection was effective, without complications and with a good long-term functional outcome. Possibility of wearing fashionable conventional shoes without insoles was achieved to the patient’s satisfaction


2021 ◽  
Author(s):  
Rikuto Yoshimizu ◽  
Junsuke Nakase ◽  
Takafumi Mochizuki ◽  
Yasushi Takata ◽  
Kengo Shimozaki ◽  
...  

Abstract BackgroundThis study investigated the whole-body skeletal muscle activity pattern of hang power clean (HPC), a major weight training exercise, using positron emission tomography (PET).MethodTwelve college weightlifting athletes performed three sets of HPC 20 times with a barbell set to 40 kg both before and after an intravenous injection of 37 MBq 18F-fluorodeoxyglucose (FDG). PET-computed tomography images were obtained 50 min after FDG injection. Regions of interest were defined within 71 muscles. The standardized uptake value was calculated to examine the FDG uptake of muscle tissue per unit volume, and FDG accumulation was compared to the control group. The Mann–Whitney U-test was used to evaluate the differences in the mean SUV between groups. The difference between SUVs of the right and left muscles was evaluated by a paired t-test. A P-value < 0.05 was considered statistically significant.ResultsFDG accumulation within the vastus lateralis, vastus intermedius, and vastus medialis was higher than that of the rectus femoris. FDG accumulation within the triceps surae muscle was significantly higher only in the soleus. In the trunk and hip muscles, FDG accumulation of only the erector spinae was significantly increased. In all skeletal muscles, there was no difference between SUVs of the right and left muscles.ConclusionsThe monoarticular muscles in the lower limbs were active in HPC. In contrast, deep muscles in the trunk and hip were not active during HPC. HPC is not suitable for core training and needs to be supplemented with other training.


Author(s):  
Raj Desai ◽  
Anirban Guha ◽  
Pasumarthy Seshu

Long duration automobile-induced vibration is the cause of many ailments to humans. Predicting and mitigating these vibrations through seat requires a good model of seated human body. A good model is the one that strikes the right balance between modelling difficulty and simulation results accuracy. Increasing the number of body parts which have been separately modelled and increasing the number of ways these parts are connected to each other increase the number of degrees of freedom of the entire model. A number of such models have been reported in the literature. These range from simple lumped parameter models with limited accuracy to advanced models with high computational cost. However, a systematic comparison of these models has not been reported till date. This work creates eight such models ranging from 8 to 26 degrees of freedom and tries to identify the model which strikes the right balance between modelling complexity and results accuracy. A comparison of the models’ prediction with experimental data published in the literature allows the identification of a 12 degree of freedom backrest supported model as optimum for modelling complexity and prediction accuracy.


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