Left Upper Limb Research Articles

Platelet-Based Dose-Adjusted Low Molecular Weight Heparin Treatment Is Efficacious and Safe in Newly Diagnosed Acute Leukemia Patients with Catheter-Related Thrombosis

Introduction: Catheter-related thrombosis (CRT) is a major complication in patients with acute leukemia. Severe thrombocytopenia related to either the concomitant disease or therapy underscores the challenge of CRT management, resulting in the use of suboptimal anticoagulation, potentially leading to high rates of short-term complications, including recurrent thromboembolism and hemorrhage. Due to the paucity of data regarding the impact of reduced-dose anticoagulation on this clinical setting, the current study aimed to assess the safety and efficacy of this treatment approach to CRT management in this challenging patient population. Methods: In this retrospective, case-control study, all adult (age ≥18 years) acute leukemia patients, who had arrived at the Rambam Health Care Campus (RHCC, Haifa, Israel) between 1.11.2004-30.6.2022 to receive anti-leukemia therapy via a peripherally inserted central catheter (PICC) line were screened. The inclusion criteria were: patients with acute myeloid, promyelocytic and lymphoid leukemia (AML, APL, and ALL, respectively) and CRT confirmed by Doppler ultrasound within 3 months of leukemia diagnosis. Patients were divided into full- (i.e., 1 mg/kg bid) vs. partial-dose low molecular weight heparin (LMWH) groups. The LMWH dose was based on the platelet count with a cutoff of 50K/L, distinguishing between the selected doses. Primary endpoints: A record of venous thromboembolism (VTE; including pulmonary embolism (PE), deep vein thrombosis (DVT), and catheter-related thrombosis (CRT) recurrence within 12 months as well as a major hemorrhage (including intracranial, retinal and gastrointestinal hemorrhage) within 6 months. Secondary endpoints: blood product requirement (unit/day) before and after the CRT diagnosis (from leukemia diagnosis till CRT identification and 90 days or death (if prior) from the event, respectively) assessed in a self-controlled case series manner. Data were collected from the hospital electronic medical records. Chi-square and paired samples Wilcoxon tests were utilized for statistical analysis. Results: Overall,195 patients [aged 54±15 years; 103 (53%) males], diagnosed with CRT were included. The most frequent leukemia diagnosis was AML (n=149; 76%), with ALL and APL established in 23 (12%) patients each. CRT was diagnosed in the left upper limb in 136 (70%) patients, with 99 (46%) patients suffering from DVT. Eighty-eight (45%) patients were treated with full-dose LMWH. Recurrent VTE was identified in 11(12.5%) patients treated with full-dose LMWH vs. 9 (8.4%) receiving partial-dose LMWH (p-value 0.484), while major hemorrhage was diagnosed in 12 (13.6%) patients from the former group vs. 14 (13.0%) patients from the latter group (table 1). Similar results were documented upon stratification to deep vs. superficial CRT, and the leukemia type. The packed red blood cell (RBC) administration rate was lower in the post-CRT phase (0.12 units/day, IQR 0.06-0.20) compared to the pre-CRT phase (0.20 units/day, IQR 0-0.36; p-value <0.0001). Platelet utilization rates were similar in both the pre-CRT and post-CRT phases (0.05 units/day, IQR 0-0.24 and 0.06 units/day, IQR 0.01-0.16, respectively; p-value 0.126). Comparable results were observed in both full and partial-dose LMWH groups. Conclusion: LMWH dose adjustment based on platelet counts, in newly diagnosed acute leukemia patients with CRT, is not associated with higher rates of VTE recurrence. Moreover, this strategy does not result in major hemorrhagic complications even in patients with severe thrombocytopenia. Notably, RBC infusion requirements were lower in the post-CRT diagnosis phase, while platelet transfusion was similar during the pre- and post-CRT phases. This analysis, including a large number of patients, demonstrates that the adjusted therapy is safe and efficient in this challenging clinical scenario.

Comparison of surgical and endovascular left subclavian artery revascularization during thoracic aortic endovascular repair: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to incorporate data from the latest clinical studies and compare the safety and efficacy of surgical left subclavian artery (LSA) revascularization and endovascular LSA revascularization during thoracic endovascular aortic repair (TEVAR). This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the PROSPERO database on 16 April 2023 (CRD42023414579). The Embase, MEDLINE (PubMed), and the Cochrane Library databases were searched from January 2000 to May 2023. A total of 14 retrospective cohort studies with a total of 1,695 patients, were included for review. The peri-operative stroke rates of the surgical and endovascular LSA revascularization groups were 3.8% and 2.6%, respectively (P = 0.97). The peri-operative technical success rates for the surgical and endovascular LSA revascularization groups were 95.6% and 93.0%, respectively (P = 0.24). The peri-operative spinal cord ischemia rates were 1.6% (n = 18) and 1.9% (n = 7) in the surgical and endovascular LSA revascularization groups, respectively (P = 0.90). The peri-operative type Ⅰ endoleak rates for the surgical and endovascular LSA revascularization groups were 6.6% and 23.2%, respectively (P = 0.25). The subgroup analysis showed that the incidence of peri-operative type I endoleak in the parallel stent group was significantly higher than that in the surgical LSA revascularization group (P < 0.0001). The peri-operative left upper limb ischemia rates for the surgical and endovascular LSA revascularization groups were 1.2% and 0.6%, respectively (P = 0.96). The peri-operative mortality rates of the surgical and endovascular LSA revascularization groups were 2.0% and 2.0%, respectively (P = 0.88). There was no significant difference in the terms of short-term outcomes when comparing the two revascularization techniques. The quality of evidence assessed by GRADE scale was low to very-low. Surgical and endovascular LSA revascularization during TEVAR were both safe and effective. Compared with surgical LSA revascularization techniques, parallel stent revascularization of LSA significantly increased the rate of type I endoleak.

A CASE REPORT OF NECROTIZING FASCIITIS OF THE NECK AND ANTERIOR CHEST WALL CAUSED BY ODONTOGENIC INFECTION IN ELDERLY: DIAGNOSIS AND MANAGEMENT IN RURAL AREA

Introduction: Necrotizing Fasciitis (NF) is bacterial infection spreading rapidly affecting soft tissue and muscular fascia. It's life threatening and fatal, leads to tissue necrosis, sepsis, and death. It has high mortality number especially in elderly. Purpose: To report a rare case of odontogenic NF in elderly patient extending to the neck, left upper limb and anterior chest wall, diagnosed and treated in district hospital with limited facilities. Case Report: A 65 years old male with painful left neck swelling and fluctuating gangrenous appearance start form the mastoid bone to infraclavicular area crossing to the right close with sternal area. Swelling and fluctuating area also found in left axillar and left arm. Thirteen hours after hospital admission, the patient was sent to operating room to do the wound debridement. Wound care was carried out daily in intensive care unit and inpatient ward. 14 days postoperatively patient was send out to continue the wound care in outpatient department. 28 days postoperatively, skin grafting was done. Conclusion: Fourteen days postoperatively patient was sent to outpatient department to continue his wound care. After wound care in order to wound prepare for skin grafting. 28 days postoperatively, 14 days after patient discharge from hospital, skin grafting was done to close the wound defect.

A rare case report: isolated midbrain lacunar infarct affecting the ipsilateral medial longitudinal fasciculus causing internuclear ophthalmoplegia effect

Isolated medial longitudinal fasciculus infarct is rare and can also be associated with cranial nerve nuclei or extra-nuclear regions leading to respective neurological deficit. We report a case of 73-year-old woman presenting with a 24 hour of confusion, abnormal eye movement and unsteady gait on a background history of uncontrolled diabetes mellitus (DM), hypertension and Alzheimer’s disease. Her examination found to have dysdiadokinesia in left upper limb and inability to adduct right eyeball on left lateral gaze, without affecting the pupil. She was not oriented to time and place while before this event she could. Her examination found to have normal power in limbs and sensation. Her computed tomography (CT) brain showed no evidence of acute infarction or intracranial bleed. Magnetic resonance imaging (MRI) brain demonstrated acute lacunar infarct involving the ipsilateral medial longitudinal fasciculus. This case demonstrates rare brainstem infarct affecting medial longitudinal fasciculus region below the IIIrd cranial nerve nucleus giving features of internuclear ophthalmoplegia affecting medial rectus muscle without affecting autonomic fibres of IIIrd cranial nerve due to which the pupil is not affected. We recommend strict control of predisposing conditions, mainly diabetes and hypertension to reduce the incidence of brainstem stroke.

Actinomicosis mamaria: presentación de un caso clínico

Breast actinomycosis is a chronic suppurative infection characterized by the presence of external fistulas in the skin of the breasts. It is rare in this location and may be primary in the mammary gland or secondary to a lung condition. We present the clinical case of a 71-year-old female patient who presented a hard tumor that compromised the entire left breast, with intense pain as well as impossibility of mobility of the left upper limb, considerable weight loss; Thoracic tomography report led to suspicion of malignant neoplasm of the breast and the result of the pathology study was a mammary Actinomycosis. For which, we emphasize the importance of a high suspicion, diagnosis and treatment for its satisfactory prognosis.

Arm levitation in multiple system atrophy

AbstractA 53‐year‐old woman presented with repetitive involuntary elevation of the left upper limb beyond her shoulder joint. Initially, the symptom was suspected to be due to a functional neurological disorder. Based on the clinical and radiological findings, however, we diagnosed arm levitation associated with multiple system atrophy. The mechanism of her arm levitation was suggested to be a disturbance of the right frontal cortex with resultant impairment of the inhibitory mechanisms of the primary motor cortex.

A Case Report of Spinal Cord Edema and Cervical Spondylosis Masquerading as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

A 64-year-old previously-healthy male presented with 2-year history of progressive neurological symptoms of numbness and muscle weakness involving all 4 limbs. There was gait disturbance, urinary and fecal incontinence. On examination, the left upper limb had normal tone, diminished deep tendon reflexes and power of 4/5 with wasting both in proximal and distal muscles. There were reduced pinprick pain and temperature sensations below the elbow bilaterally with intact vibration and proprioception. Both lower limbs had increased tone, diminished deep tendon reflexes, power of 3/5 with wasting both in proximal and distal muscles with unequivocal plantar reflex bilaterally. There were reduced pinprick pain and temperature sensations below the knee on right and below the ankle on left with intact vibration and proprioception. Nerve Conduction Studies (NCS) were done which showed axonal type of denervation in all limbs. MRI scan of Cervical Spine showed T2W hyperintense signals and narrowing of spinal canal from C3 to C7 region. The final diagnosis was spinal cord edema in the cervical region and cervical spondylosis causing spinal cord compression. Keywords: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Spinal cord edema, Cervical spondylosis, Nerve Conduction Studies (NCS), MRI scan, Case report.

Left Upper Limb Deep Venous Thrombosis: A Rare Condition Becoming Common Nowadays

Deep venous thrombosis of the upper limb is a less common phenomenon than lower limb deep vein thrombosis. The commonest reasons are trauma secondary to sport or job related arm movements and arm positions, predisposing for upper limb deep venous thrombosis. In this case report, we will discuss the diagnosis and management of upper limbs deep vein thrombosis, along with review of literature.

Effects of altered functional connectivity on motor imagery brain–computer interfaces based on the laterality of paralysis in hemiplegia patients

Motor imagery (MI)-based brain–computer interfaces are widely employed for improving the rehabilitation of paralyzed people and their quality of life. It has been well documented that brain activity patterns in the primary motor cortex and sensorimotor cortex during MI are similar to those of motor execution/imagery. However, individuals paralyzed owing to various neurological disorders have debilitated activation of the motor control region. Therefore, the differences in brain activation based on the paralysis location should be considered. We analyzed brain activation patterns using the electroencephalogram (EEG) acquired while performing MI on the right upper limb to investigate hemiplegia-related brain activation patterns. Participants with hemiplegia of the right upper limb (n=7) and left upper limb (n=4) performed the MI task within the right upper limb. EEG signals were acquired using 14 channels based on a 10–20 global system, and analyzed for event-related desynchronization (ERD) based on event-related spectral perturbation and functional connectivity, using the weighted phase-lag index of both hemispheres at the location of hemiplegia. Enhanced ERD was found in the ipsilateral region, compared to the contralateral region, after MI of the affected limb. The reduced difference in the centrality of the channels was observed in all subjects, likely reflecting an altered brain network from increased interhemispheric connections. Furthermore, the tendency of distinct network-based features depending on the MI task on the affected limb was diluted between the inter-hemispheres. Analysis of interaction between inter-region using functional connectivity could provide avenues for further investigation of BCI strategy through the brain state of individuals with hemiplegia.

Anatomical variations in morphology of right and left brachial plexus among black African population; a cadaveric study in western Kenya

Background: Brachial plexus (Bp) is a network of bundles of nerves of spinal cord around neck and axilla in the body formed by union of anterior primary rami of C5 to C8, and T1. Technical expertise required for clinical and surgical procedures remains challenging for the beginners. Variations may be due to trauma, irradiation, neoplasm, infection, and autoimmune inflammatory disease. The purpose of this study was to determine the difference in variation of right and left Bp of the study population. Methods: Cross sectional descriptive study was used in Maseno, Uzima and Masinde Muliro Universities anatomy laboratory to get sample size of 35male and 35 female cadavers. Chi- square test was set at a p= 0.05. Ethical consideration was observed. Results: Statistically significant difference (p=0.009) between the right and the left upper limb in the branching of musculocutaneous nerve was recorded. A total of 17.8% variations in origin and segments of Bp, majority 9.9% were from left while 7.9% from right. Highest frequency of variation occurred at the prefixed root of Bp with 8.7% occurring on left upper limb and 12.13% on right upper limb. Right upper limbs had highest incidence of variations in branching patterns of Bp at 43% whilst left had incidence of 23.5%. Highest frequency of main terminal variation was of musculocutaneous nerve at 18.6% with 13.6% occurring on right side and 5% on left side. Conclusion: Knowledge of variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to the upper limb.

Role of Pulse Oximetry as a Screening Tool for the Detection of Congenital Heart Disease in Newborn Babies

Background: Congenital heart disease (CHD) is one of the commonly seen malformations, with incidence varying from 7 to 8/1000 live birth. Causes are multifactorial. Routine examination of neonates may miss more than 50% of cases. Pulse oximetry is a simple, noninvasive, bedside test which estimates the percentage of oxygen bound to hemoglobin (oxygen saturation [SpO2]). Detection of critical CHD (CCHD) has been possible with SpO2 screening. Many countries included SpO2 as part of newborn screening due to this. As a primary approach, both pre- and post-ductal extremity SpO2 is measured after 24 h of life. Echocardiography (ECHO) will be done on neonates with SpO2 readings &lt;95%. Neonates born in high-altitude regions, studies have suggest to use adjusted threshold values. In India, there are limited studies. Aims: The aim of this study was to determine the usefulness of pulse oximetry as a screening tool for early detection of CHD in otherwise asymptomatic newborns. To determine, the accuracy of SpO2 for detecting clinically unrecognized CCHD in newborns. Materials and Methods: This is a prospective observational study done in the department of pediatrics in a tertiary hospital. The study was conducted over 12 months. During the study period, all neonates born who fulfilled the inclusion criteria were included in the study. After 24 h of life, neonates were examined clinically and the pre- and post-ductal SpO2 was measured. Neonates with SpO2 &lt;90% in room air were excluded from the study. If the SpO2 was between 90% and 94%, clinical examination was repeated, if suspicious of CHD, they were referred for ECHO. If there was no suspicion of CHD, SpO2 was repeated after 6 h and ECHO was done if SpO2 ≤95. The difference of SpO2 &gt;3% between the right upper limb and right lower limb was considered positive. Positive neonates were evaluated with two-dimensional echocardiograph. Inclusion criteria - All hemodynamically stable neonates were born during the study period. Exclusion criteria (1) Antenatally diagnosed cardiac anomalies, (2) Outborn neonates, (3) Parents/guardians are not willing to participate in the study and/or further investigation, (4) Sick neonates and those with SpO2 &lt;90% at birth. Results: 1117 (83.7%) were eligible for the study out of 1333 neonates born. 669 (59.9%) were born by cesarean section and 448 (40.1%) by vaginal delivery. 996 (89.2%) were born at term (≥37 weeks of gestation) and 121 (10.8%) were preterm (&lt;37 weeks of gestation). The male-to-female ratio was 1.03:1. The mean birth weight of the neonates was 2.91 ± 0.46 kg (mean ± standard deviation). The mean SPO2 in the right upper limb was 96.62 ± 1.73, in the right lower limb was 96.87 ± 1.76, in the left upper limb was 96.59 ± 1.90, and in the left lower limb was 97.06 ± 1.74. The average SPO2 difference between the right upper limb and right lower limb was 1.04 ± 1.07. Based on SpO2, 858 (76.8%) cases were not suspected of having CHD and 259 (23.3%) were suspected of having CHD and were evaluated with ECHO. Six (0.5%) neonates had CHD in whom echo was done. In our study, for detecting CCHD, SPO2 cutoff value of ≤90% showed 90% sensitivity, 99.94% specificity, 75% positive predictive value, and 99.98% negative predictive value. Conclusions: This study emphasizes noninvasive SPO2 as reliable and feasible, with good negative predictive value screening for CHD in neonates.

A 30-Year-Old Pregnant Woman Presented With Altered Consciousness During Vaginal Delivery

&lt;p&gt;懷孕婦女併發腦血管意外是罕見的產科急症，其中重要的危險因素是子癲前症。本文案例是一位 30 歲初次懷孕39週又3天婦女，無特殊疾病史， 入院待產時出現高血壓合併蛋白尿，被診斷為子癲前症，於自然生產時發生嗜睡及意識改變。醫療團隊藉由神經學檢查及電腦斷層掃描診斷為腦梗塞，立即給予血栓溶解劑治療。治療中密切監測覺察病人有新的神經學異常，立即再度執行電腦斷層掃描，發現後續發生的右側大腦出血，緊急行顱骨切開手術清除血塊。術後病人仍有明顯的左側偏癱，經過積極的復健治療，出院時左上肢肌力3分，左下肢肌力4分，可使用拐杖步行移動。對於子癲前症的高危險妊娠，從待產、生產以至產後過程，均應密切監測血壓及神經學變化，如併發嗜睡及意識改變時，應快速及正確做相關腦血管疾病的鑑別診斷，早期診斷發現，預防惡化再發生，期能在中風黃金時間三小時內及早治療，降低病人殘障、失能及死亡的機率。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Stroke is an uncommon but serious potential complication of pregnancy. A 30-year-old woman was in her 39+3 weeks of first pregnancy without any past medical history . After admission, she was diag&amp;shy;nosed as preeclampsia due to hypertension with p1roteinuria. Drowsiness and changes of conscious&amp;shy;ness occurred during delivery. The neurological examination and brain CT scan revealed cerebral infarction and thrombolysis was performed. During the treatment new neurological abnormalities was found, CT scan was immediately performed again. Right cerebral hemorrhage was confirmed and an emergency craniotomy was performed. After the operation, the patient still suffered from obvious left hemiplegia. After active rehabilitation treatment, the muscle strength of the left upper limb was 3 points and the muscle strength of the left lower limb was 4 points at the time of discharge, and she could walk with crutches. For high-risk pregnancy with preeclampsia, blood pressure and neurological changes should be closely monitored during labor, delivery, and postpartum. If symptoms as drowsi&amp;shy;ness and changes in consciousness are shown, the differential diagnosis of related cerebrovascular dis&amp;shy;eases should be made quickly and correctly. To prevent the recurrence of deterioration, early treatment is expected within three hours of the prime time of stroke. The probability of handicapped, disability and death of patients can be reduced.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Comparison of Muscle Mass Between Healthy Subjects and Patients With Malignant Tumors Undergoing Outpatient Treatment.

Background In recent years, advances in the treatment of malignant tumors have improved life expectancy and diversified treatment options. However, maintaining high activities of daily living in patients is essential for appropriately treating the primary disease, and interventions for patients with impaired motor function will lead to improved quality of life. Here, we compared the muscle mass of malignant tumor patients who are visiting bone metastasis outpatient clinics with that of healthy subjects. Methods We compared the muscle mass of 61 malignant tumor patients with an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (mean 66.3 ± 12.0 years; 30 males and 31 females) attending our bone metastasis outpatient clinic since 2018 with that of 315 healthy subjects (mean 65.0 ± 17.7 years; 110 males and 205 females). Body mass index, skeletal muscle mass, and body fat percentage were assessed by bioimpedance analysis, and the skeletal muscle mass index (SMI) was calculated. Results To eliminate age bias in the malignant tumor patients and healthy subjects, 1:1 propensity score matching was performed separately for males and females. There was no significant difference in right upper limb, left upper limb, right lower limb, or left lower limb mass or SMI between the two groups, whereas trunk muscle mass and muscle mass were significantly higher in the healthy females compared with malignant tumor females. Conclusion There was no significant difference in the SMI measured by bioimpedance analysis between the two groups in either males or females, while muscle mass and trunk muscle mass were significantly lower in female malignant tumor patients than in healthy subjects. These results suggest that even malignant tumor patients whose performance status was maintained enough to allow outpatient visits still had impaired motor function.

Cerebral Infarction Due to Polycythemia Vera: A Case Report

Introduction: Changes in blood viscosity can cause thrombosis in the brain, causing a stroke. Polycythemia vera is one of the causes of blood hyperviscosity. This study aimed to present cases of cerebral infarction related to polycythemia vera.&#x0D; Case presentation: A 55-year-old woman came to the emergency room with complaints of sudden weakness in the left limbs. One week before admission, the patient complained of headaches accompanied by spinning dizziness. Her left limbs often tingled and became weaker. There was an asymmetric facial deviation to the right, and the patient had difficulty communicating with unclear articulation. Specific examination of neurology shows dysarthria, left-sided motor type facial paralysis, examination of motor strength of the upper and lower extremities on the left 2 and 5 on the right, and the left upper limb often feels tingling. On the left limb, normal physiological biceps reflex was found, positive Chaddock pathological reflex. Morphological examination of peripheral blood showed normocytic normochromic with erythrosis and thrombocytosis and found giant platelets. This patient was diagnosed with an ischemic stroke caused by cerebral infarction, with polycythemia vera etiology, and accompanied by comorbid diseases of diabetes mellitus and uncontrolled hypertension.&#x0D; Conclusion: In patients with high-risk criteria for thrombosis, the management of phlebotomy, administration of low-dose aspirin, and cytoreduction in the form of hydroxyurea aims to achieve a hematocrit &lt;45% so as to prevent worsening and recurrence of stroke.

Anatomical and biometric study of the radial artery on human cadavers dissected in the anatomy laboratory.

To study the anatomy and biometry of the radial artery and to report the implications of this study for daily practice in Cardiac Surgery. Radial arteries from 45 human cadavers (28 males and 17 females, average age 79.2 (92) fixed in 10% formalin were dissected. The proximal and distal internal calibers and lengths of these radial arteries were measured. Our results showed the presence of a single radial artery variation in 2.3% of the entire sample (1.1% of the 90 dissected upper limbs). The distance between the epicondyle and the emergence of the radial artery was 32.4 (6.67) mm in men and 30.7 (9.00) mm in women, with an average of 31.8 (7.58) mm. For the right upper limb, the mean proximal internal caliber of the radial artery was 3.16 (0.56) mm and its mean distal internal caliber was 2.62 (0.66) mm. For the left upper limb, the mean proximal internal caliber of the radial artery was 3.17 (0.59) mm and its mean distal internal caliber was 2.64 (0.68) mm. The mean length of the left radial artery was 197.0 (17) mm. The mean length of the right radial artery was 201.0 (33) mm. It is very important to be aware of the possible anatomical variation of the radial artery. Despite its rarity, this knowledge may ensure a better safety and reliability of the harvesting technique for use as a graft.

Characterizing the effects of an ergonomic handle on upper limbs kinematics and neuromuscular activity, comfort, and performance during ergometer rowing

Articular stress and discomfort during repetitive movements may impact the risk of injuries of the upper limbs during ergometer rowing, especially when using a regular circular handle. Therefore, the purpose of the study was to propose and evaluate the influence of an ergonomic handle on upper limbs biomechanics, comfort and performance during ergometer rowing. An ergonomic irregular hexagon handle, with a 1:1.25 width/length diameters ratio, has been developed. Left upper limb kinematics and neuromuscular activity, perceived comfort and power production were monitored for 29 expert rowers. The ergonomic handle increased the perceived comfort while maintaining the overall articular stress and performance as the same level compared to the regular handle. We recommend using irregular hexagon handles with 1:1.25 ratio for ergometer rowing. Further improvements of the ergonomic handle such as an individualization based on the user's hand length may further enhance comfort and achieve better performance.

Postoperative Spinal 18F-FDG PET Pseudoprogression Mimicking Malignancy.

A 60-year-old woman presented with left upper limb weakness. Spinal MRI revealed C2-C3 heterogeneous mass with no hypermetabolic foci on 18F-FDG PET. Total resection was performed, and the pathology showed gliosis. Her limb weakness worsened 3 months after surgery. Spinal MRI revealed long intramedullary mass from medulla oblongata to C5, which showed obvious hypermetabolism under 18F-FDG PET with an SUVmax of 7.11, but 18F-FET PET indicated mild hypermetabolism with an SUVmax of 2.29. Malignancy was suspected, and C2-C4 biopsy was performed. The pathology results confirmed the diagnosis of gliosis, and the postoperative spinal 18F-FDG PET results were considered pseudoprogression.

A Single-center, Seven Years Retrospective Study to Analyze the Outcomes of Acute Upper Limb Ischemia (AULI) in Northern India

ABSTRACT Background: Acute upper-limb ischemia (AULI) is not always as limb-threatening as those in the leg, so thrombo-embolectomy is not always as necessary for limb salvage. Objective: To evaluate “the outcomes of limb and life at the end of one month, in patients with AULI” and to analyze the following factors: presentation from the time of the acute event, evaluation of limb at the time of presentation regarding its viability, and compare the outcomes in early presentation vs late presentation. Methodology: This was a retrospective study; hence, clinical profiles of all patients during the past seven years were reviewed for those presenting with AULI. Data on anticoagulation were collected, imaging and operative procedures were extracted. All statistical analyses were performed using SPSS 11.0 for Windows. Results: In our study, 25 (42.4%) patients were included due to native arterial thrombosis, 11 (18.6%) due to embolic disease, and the same percentage due to exposure to a high-altitude area (HAA) (more than 9000 feet). 4 (6.8%) patients had thoracic outlet syndrome and cervical rib, and 5 (8.5%) had hypercoagulable disorder. Our study population was younger with a mean of 44.9 years with an SD of 13, and the majority were male (5 out of 59 were female). 16 were active smokers, and 2 were former smokers. The left upper limb incidence was 59% (n = 35), and the right upper limb was 41% (n = 24). In our study, the most common site was the brachial artery 53% (26 out of 49) and axillary artery 35% (17 out of 49) when iatrogenic, traumatic, and thoracic outlet syndromes are excluded. Out of the 59 patients, 39 patients had undergone color Doppler flow imaging of the affected limb and 30 patients had undergone CT angiography of the arch and the limb. Two patients presented with gangrene to the forearm, and 12 patients underwent Colour doppler flow imaging (CDFI) before they presented to our center. In our study, 37% of the patients presented within 48 hours of the onset of symptoms, out of which above-elbow amputation was done in only 1 patient, that is, 4.5%, and 24% of the patients presented within an 8–14-day period, among which one patient (11%) had undergone above-elbow amputation and 22% of the patients presented after 14 days, in which there were 2 above-elbow-amputation patients (15%) with a statistically non-significant P value of 0.5. A total of 45 patients were managed with anticoagulation. A detailed discussion on the treatment outcome of each case has been presented in the article. Conclusion: CT angiography, when available, is a well-accepted first-line investigation for AULI. When we compare AULI with lower-limb ischemia, collateral circulation conservative management is also an option, provided that it is not associated with tissue loss. AULI like lower-limb ischemia has better limb salvage when diagnosed and intervened early.

The role of fluid-sensitive MRI in early diagnosis of post-COVID-19 unusual motor neuropathies

Post-COVID-19 motor neuropathies frequently result atypical for location and contemporary involvement of different nervous districts. These aspects often complicate the electromyography (EMG) diagnosis. Inducing severe and atypical forms of disability, motor mononeuropathies early recognition is of primary importance for a specific rehabilitation treatment. Several evidence supported magnetic resonance (MRI) as a useful tool in the early diagnosis of muscle denervation. We describe the case of a 57-year-old male patient with a severe post-COVID-19 motor deficit in the proximal region of left upper limb, with a significant limitation in left shoulder abduction. MRI, required in suspected tendinopathy, showed a high hyperintensity signal in the “fluid sensitive” sequences of both supraspinatus and infraspinatus muscles, suggesting denervation of these muscle districts in a selective, severe injury of the left suprascapular nerve. This diagnostic hypothesis was subsequently confirmed by EMG. This clinical case confirms that MRI could represents a valuable supplementary resource in unusual post-COVID-19 motor neuropathies diagnosis, allowing an early and specific rehabilitation.

Takayasu arteritis in a young male patient: a case report and review of literature.

Takayasu arteritis is a systemic inflammatory disorder that causes harm to the large and medium arteries and their branches. It is primarily prevalent in Asia, Africa, and Latin America, with the incidence rate in Asia being reported to be 100 times higher than in Europe and North America. Females in their second or third decades of life are most commonly affected by this condition. In our case, a 26-year-old male patient was diagnosed with Takayasu arteritis after he experienced a headache and left upper limb weakness. The initial presentation of Takayasu arteritis includes nonspecific constitutional symptoms like fever, malaise, weight loss, and anorexia. Unfortunately, due to the delayed diagnosis of the disease, patients often experience claudication, absence of pulses, hypertension, myocardial infarction, and cerebrovascular accidents. An early and accurate diagnosis of Takayasu arteritis is vital to reduce the economic, social, and psychological burdens associated with the disease.