Physical Therapy Following Saucerisation of Discoid Meniscus – a Case Study

Introduction: Discoid meniscus is a structure with altered shape, which causes it to frequently undergo injuries and lesions. Pain, limping, limited range of motion of the knee joint and swelling are characteristic signs of this pathology. Therapeutic possibilities include meniscectomy and saucerisation. Research objective: The study aim was assessment of the therapeutic effectiveness in a patient after saucerisation of discoid meniscus. Material and methods: A 12-year-old female patient after saucerisation of lower left limb lateral discoid meniscus (type I) was subjected to 32-week physical therapy treatment. Testing included determining the range of knee joint flexion and extension movements, as well as measuring the circumference of the lower extremities 15 cm above the patella. The Kujala Score (Anterior Knee Pain Scale) and Ikeuchi grading system were employed during the 1st, 3rd, 8th, 21st and 32nd weeks postoperatively. Results: In the final stage of physical therapy, complete range of knee joint motion was achieved, the Kujala Scale score totalled 98 points and the thigh circumference of the operated limb increased by 4 cm. The circumferences of the lower extremities differed by 2 cm in the final phase of physical therapy. Conclusions: The employed postoperative protocol effectively influenced the functional state of the patient.

Molecular Imaging of Lower Extremity Peripheral Arterial Disease: An Emerging Field in Nuclear Medicine

Peripheral arterial disease (PAD) is an atherosclerotic disorder of non-coronary arteries that is associated with vascular stenosis and/or occlusion. PAD affecting the lower extremities is characterized by a variety of health-related consequences, including lifestyle-limiting intermittent claudication, ulceration of the limbs and/or feet, increased risk for lower extremity amputation, and increased mortality. The diagnosis of lower extremity PAD is typically established by using non-invasive tests such as the ankle-brachial index, toe-brachial index, duplex ultrasound, and/or angiography imaging studies. While these common diagnostic tools provide hemodynamic and anatomical vascular assessments, the potential for non-invasive physiological assessment of the lower extremities has more recently emerged through the use of magnetic resonance- and nuclear medicine-based approaches, which can provide insight into the functional consequences of PAD-related limb ischemia. This perspectives article specifically highlights and discusses the emerging applications of clinical nuclear medicine techniques for molecular imaging investigations in the setting of lower extremity PAD.

Conversion from dose-length product to effective dose in computed tomography venography of the lower extremities

For radiation dose assessement of computed tomography (CT), effective dose (ED) is often estimated by multiplying the dose-length product (DLP), provided automatically by the CT scanner, by a conversion factor. We investigated such conversion in CT venography of the lower extremities performed in conjunction with CT pulmonary angiography. The study subjects consisted of eight groups imaged using different scanners and different imaging conditions (five and three groups for the GE and Siemens scanners, respectively). Each group included 10 men and 10 women. The scan range was divided into four anatomical regions (trunk, proximal thigh, knee and distal leg), and DLP was calculated for each region (regional DLP). Regional DLP was multiplied by a conversion factor for the respective region, to convert it to ED. The sum of the ED values for the four regions was obtained as standard ED. Additionally, the sum of the four regional DLP values, an approximate of the scanner-derived DLP, was multiplied by the conversion factor for the trunk (0.015 mSv/mGy/cm), as a simplified method to obtain ED. When using the simplified method, ED was overestimated by 32.3%−70.2% and 56.5%−66.2% for the GE and Siemens scanners, respectively. The degree of overestimation was positively and closely correlated with the contribution of the middle and distal portions of the lower extremities to total radiation exposure. ED/DLP averaged within each group, corresponding to the conversion factor, was 0.0089−0.0114 and 0.0091−0.0096 mSv/mGy/cm for the GE and Siemens scanners, respectively. In CT venography of the lower extremities, ED is greatly overestimated by multiplying the scanner-derived DLP by the conversion factor for the trunk. The degree of overestimation varies widely depending on the imaging conditions. It is recommended to divide the scan range and calculate ED as a sum of regional ED values.

EMG-Triggered Pedaling Training on Muscle Activation, Gait, and Motor Function for Stroke Patients

This study aimed to determine the effects of electromyography (EMG)-triggered pedaling training to improve motor functions in the lower extremities, muscle activation, gait, postural balance, and activities of daily living in stroke patients. Subjects were randomly allocated to two groups: the EMG-triggered pedaling training group (EMG-PTG, n = 21) and the traditional pedaling training group (TPTG, n = 20). Both groups trained five times per week for four weeks, with 50 min per session. Lower extremity motor function was assessed using the Fugl–Meyer Assessment (FMA). Muscle activation of the four muscles of the lower extremities was assessed using eight-channel electromyography, while gait ability was assessed using GaitRite. Postural balance was assessed using the Berg balance scale (BBS), the timed up and go (TUG), and functional reach tests (FRT). Daily activities were assessed using the Modified Barthel Index (MBI). For lower extremity motor function, gait ability, balance ability, and activities of daily living, the EMG-PTG showed significant improvement compared to TPTG (p < 0.05). These results suggest that EMG-triggered pedaling training effectively improves lower extremity motor function, muscle activation, gait, postural balance, and activities of daily living in stroke patients.

Dermoscopy of pilomatricoma: A case report with a review of the literature

Pilomatricoma is a benign tumor originating from hair follicle matrix cells and characterized by the presence of cutaneous and subcutaneous nodules up to 3.0 cm in diameter, usually on the head, neck, and upper extremities, rarely on the trunk and lower extremities. An eleven-year-old female with a painless, erythematous-purplish tumor of the back. A dermoscopic examination revealed irregular linear vessels, white structures, and structureless grayish-blue areas. Histological examination after excision confirmed the diagnosis of pilomatricoma. Dermoscopy may be a useful tool for improving the clinical recognition of pilomatricoma.

Patient-Telemonitoring After Revascularization Procedures in the Lower Extremities

Multidisciplinary cooperation of participating healthcare professionals, use of common standards in diagnostics, and clinical pathways in the treatment of vascular patients should provide for a higher-quality clinical practice. Using telemedicine, a more efficient way of obtaining specialist treatment is achievable. However, its introduction may raise safety and security issues, which originate from its enabling information technology. In this chapter, a model of patient-telemonitoring after revascularization procedures in the lower extremities is presented. A protocol for proper authentication and authorization to access medical equipment and patient medical records has been introduced. The associated clinical study has shown that most post-operative follow-up examinations can successfully be performed by trained nurses. Hence, improvements to healthcare logistics, mainly due to shortening waiting times for specialist treatment and the reduction of follow-up examinations on the secondary healthcare level, can be achieved using telemedicine.