Limbs Of Young Adults Research Articles

Pressão arterial sistólica e circunferência do braço são os melhores preditores da pressão de oclusão arterial em adultos jovens

Abstract Introduction Low-intensity resistance training combined with blood flow restriction has shown to be effective in musculoskeletal rehabilitation. The appropriate arterial occlusion pressure (AOP) to induce partial blood flow restriction has been suggested through regression equations. Objective This study sough to investigate whether limb fat-free mass and fat mass can be used as predictors of AOP in the upper limbs in young adults. Methods Vascular Doppler ultrasound was performed in the proximal right arm of 49 healthy individuals of both sexes (aged 18-30 years) to determine AOP in the brachial artery. Segmental fat mass and fat-free mass were estimated by multifrequency bioelectrical impedance. The best fit model to predict AOP was tested by including the independent variables one by one in a hierarchical regression analysis. Results Systolic blood pressure (SBP) alone explained 54.6% of the variation in AOP. Included in different models in combination with SBP, arm circumference (8.1%), body mass index (7.9%), and arm fat-free mass (7.1%) composed similar models in terms of goodness of fit. Arm fat mass (1.7%), in turn, did not add predictive strength to the model. Conclusion SBP and arm circumference may be used to estimate the cuff pressure to induce blood flow restriction in blood flow restriction therapy.

The immediate effect of different loads does not alter muscle co-activation of the upper limb in young adults with dyskinetic cerebral palsy.

There is insufficient information on muscle co-activation in the upper limbs to help healthcare providers develop treatment programs for patients with dyskinetic cerebral palsy (DCP). Is the degree of muscle co-activation greater in adults with DCP than in healthy individuals? Does the use of different arm weights modify co-contraction in individuals with PCD? Fourteen healthy individuals (control group [CG]) and 14 individuals with DCP (dyskinetic group [DG]) participated in the study. The degree of muscle co-activation of the dominant limb during drinking from a mug was compared between the two groups. The task was divided into a going, adjusting, and returning phase. In the DG, an analysis was also performed on using an arm weight during the functional task. The loads corresponded to 10, 20, and 30 % of maximum isometric muscle strength measured in each participant. In comparing the two groups, the DG exhibited a greater muscle co-activation in the shoulder and elbow muscles during the going phase, the shoulder, elbow, and wrist during the adjusting phase; and the elbow during the returning phase. The DG also showed a greater mean index of curvature (MIC), time to perform the movement phases, and lesser mean velocity (Vm) to drinking. In analyzing the DG's arm weight, no effect on co-activation, MIC, time to perform the movement phases, and Vm to drinking were found with the loads tested (p > 0.05). Muscle co-activation is increased in adults with DCP in comparison to healthy individuals. Moreover, arm weight during the functional activity of drinking from a mug did not alter co-activation, although an immediate effect was expected.

Mobility and joint range of motion in adults with cerebral palsy: A population-based study

Objective. The aim of this study was to describe the methods of mobility used in the community in relation to subtypes of cerebral palsy (CP), level of gross motor function and passive joint range of motion (PROM) in the lower limbs in young adults. Methods. From a total population of people with CP, 102 young adults (63 males) aged 18–23 years (median 20 years) participated. All subtypes were represented and the Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) levels were I n = 38, II n = 21, III n = 13, IV n = 10 and V n = 20. The Functional Mobility Scale 500 metres (FMS500m) level was analysed in relation to PROM using chi-squared tests. Relative risk was used to investigate the relationship between PROM and mobility. Results. All participants either walked without aids or used a wheelchair to move or transport themselves 500 m. Significant associations were found between FMS500m and PROM in the knee and ankle joints. Limited PROM in popliteal angle and knee extension was associated with use of a wheelchair, while limited foot dorsiflexion was associated with walking without support in the community. Conclusion. Method of mobility was associated with PROM of the knee and ankle joints for all GMFCS-E&R levels and subtypes of CP. To be able to continue to walk in adulthood, successful prevention of severe knee contractures, and avoiding excessive lengthening of the calf muscles and tendons, seem important for children with CP who are able to walk.

Epithelioid sarcoma of the spine: Case report and literature review

Epithelioid sarcomas are rare mesenchymal neoplasms mainly arising in the limbs of young adults. We report the case of a 24-year-old male presenting low back pain radiating to both lower limbs, constipation and urinary retention. The MRI scan showed an intraspinal lesion extending from L4 to S2. Surgery resulted in gross total removal of the extradural lesion and partial removal of the intradural component. The immunohistological study of the lesion was consistent with an epithelioid sarcoma. The patient was submitted to radiotherapy and chemotherapy, but a local recurrence of the lesion and dissemination along the neuraxis were observed 3 months after surgery. Despite treatment, the patient died 4 months after the surgical procedure due to multiorgan failure. Despite there being isolated reports of epithelioid sarcomas appearing in the spine, this is, to our knowledge, the first case with intradural extension.

Retiform Hemangioendothelioma on the Finger

Retiform Hemangioendothelioma on the Finger

Giant cell collagenoma on the palm

ejd.2011.1521 Auteur(s) : Ji-Youn Park, You Chan Kim maychan@ajou.ac.kr Department of Dermatology, Ajou University School of Medicine, San 5 Woncheon-dong, Suwon 443-721, Republic of Korea Giant cell collagenoma (GCC) is a rare, benign, cutaneous, fibrous tumor that usually affects the face, trunk and upper limbs of young adults [1]. Since its first description, there have been only two additional case reports considered as GCC in the English literature [2, 3]. We report another case of GCC [...]

Brodie’s abscess presenting in a young soccer player following ankle injury

Brodie’s abscess is a localized form of subacute osteomyelitis that typically occurs in the growing ends of long bones in the lower limbs of young adults. It is rare and potentially serious if the diagnosis is delayed. A high index of suspicion is required to diagnose the condition and persistent pain following an injury should alert the treating doctor to the possibility of this condition and not to simply attribute the pain to the original injury. This letter aims to highlight this rare occurrence with the case of an 11-year-old soccer player who suffered a noncontact eversion injury to his right ankle. At initial presentation he was found to have an avulsion fracture of the right medial malleolus on plain radiographic evaluation and was managed with below knee cast immobilisation for 4 weeks. Ten weeks following the injury he began to feel increasing discomfort in the anterior aspect of his right distal shin. Subsequent radiographs of his right ankle showed a lesion in the lower tibial metaphysis, which was of mixed sclerotic and lytic nature that did not appear to breach the cortex with no associated periosteal reaction. Subsequent magnetic resonance imaging (MRI) of the right ankle demonstrated a well-defined lesion crossing the growth plate in keeping with a Brodie’s abscess (Fig. 1). Contemporaneous haematological investigations revealed a raised C-reactive protein (CRP) at 19.5 mg/l (normal \ 5 mg/l) with a normal white cell count (WCC) and erythrocyte sedimentation rate (ESR). Aerobic and anaerobic blood cultures failed to grow any organisms. Despite antibiotic therapy, his blood tests showed a worsening picture of inflammation and he developed erythema over the lateral aspect of his right ankle. He was subsequently taken to theatre and 8 ml of pus was aspirated from his ankle joint. Culture of the pus aspirated from the ankle grew no organisms. He underwent further operative washout of his right ankle 4 days later and completed a 6-week course of antibiotics. Following this, he went on to make a good recovery and at 1-year follow up he is asymptomatic and back playing soccer. A Brodie’s abscess may be mistaken for a variety of neoplasms including Ewing’s sarcoma and osteoid osteoma. In as many as 50% of cases, subacute osteomyelitis is confused with tumour and biopsy is sometimes required for definitive diagnosis [1]. The incidence of osteomyelitis in children is 2.9 new cases per 100,000 population per year [2]. Pain is the most consistent symptom and constitutional symptoms are usually mild. C-reactive protein (CRP) has been found to be superior than ESR or WCC in monitoring the effectiveness of therapy and predicting recovery from acute haematogenous osteomyelitis [3]. Blood cultures are seldom positive and abscess culture may be negative in as many as 50% of cases [4]. This may in part be because the patient has already received antibiotic treatment. If cultures are positive then typically Staphylococcus aureus is isolated [4], although a number of other causative organisms such as streptococci, pneumococci, and Gram-negative bacteria have also been isolated [2]. Magnetic Resonance (MR) Imaging is a useful tool for evaluating patients with osteomyelitis and has been shown to be superior to bone scanning. MR provides better soft tissue resolution and is more useful in differentiating S. P. Edmundson (&) K. M. Hirpara P. O’Grady Department of Trauma and Orthopaedics, Mayo General Hospital, Castlebar, County Mayo, Ireland e-mail: stevenedmundson@yahoo.co.uk

Pediatric cubital tunnel syndrome by anconeus epitrochlearis: A case report

After carpal tunnel syndrome, cubital tunnel syndrome is the most frequent compressive neuropathy of upper limb in young adults, but is extremely rare in children. Ulnar nerve compression in the cubital tunnel can have different causes, including trauma (ulnar nerve injury after elbow fracture or dislocation, cubitus varus or valgus, overuse syndrome), tourniquet paralysis, congenital anomalies (accessory muscle), local swelling due to metabolic or endocrine disease (pregnancy, acromegaly, thyroid disease, amyloidosis, pseudotumoral calcinosis), and systemic disease (rheumatoid arthritis, systemic erythematosus lupus, sclerodermia). 12 We report on a 13-year-old patient with cubital tunnel syndrome due to anconeus epitrochlearis.

Synovial Sarcoma of the Maxillary Sinus Arising from Fibrous Dysplasia: A Case Report

We report on a 70-year-old female who developed synovial sarcoma of the maxilla in the setting of long-standing fibrous dysplasia of the facial skeleton. Synovial sarcoma represents approximately 10% of all soft tissue sarcomas, and most commonly occurs in the limbs of young adults. In 5 to 10% of patients, the tumor arises in the head or neck. The most common site is in the hypopharynx, but it has been described in the paranasal sinuses. There have been only two previously reported cases of synovial sarcoma arising in the maxillary sinus. Fibrous dysplasia has been shown to have the potential to transform into malignant neoplasms, although there is only one reported case of the development of synovial sarcoma after diagnosis of fibrous dysplasia, which occurred in the tibia. Our patient was initially treated with chemotherapy, which failed to control the disease. She subsequently underwent a total maxillectomy and orbital exenteration with complete resection of the tumor. Microvascular free tissue transfer was used for reconstruction, and she is undergoing postoperative radiation therapy. We discuss the manifestation of fibrous dysplasia and synovial sarcoma in the skull base, and review their diagnosis and treatment.

Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults

Stress reaction in bone, which may proceed to a fracture, is a significant problem in military recruits and in athletes, particularly long distance runners. To evaluate the evidence from randomised controlled trials of interventions for prevention or management of lower-limb stress fractures and stress reactions of bone in active young adults. We searched the Cochrane Musculoskeletal Injuries Group Specialised Register (April 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to September week 1, 2004), EMBASE, CINAHL, Index to UK Theses, reference lists of relevant articles and contacted trialists. Any randomised or quasi-randomised trials evaluating interventions for preventing or treating lower limb stress reactions of bone or stress fractures in active young adults. We independently selected trials for inclusion, assessed trial quality and extracted data. Only limited data pooling was undertaken. We included 16 trials. All 13 prevention trials involved military recruits undergoing training. Participants of two of the three treatment trials were military personnel. Ten prevention trials tested the effects of various foot inserts and other footwear modifications. While pooling of data was not possible, the four trials evaluating the use of "shock-absorbing" boot inserts versus control found fewer stress injuries of the bone in their intervention groups. However, the only trial showing a significant benefit lacked important information about trial design. A key issue in several trials was the acceptability, in terms of practicality and comfort, of the boot inserts. Two cluster-randomised prevention trials found no significant effect of leg muscle stretching during warm up before exercise. Pooled data from three small but very different trials testing the use of pneumatic braces in the rehabilitation of tibial stress fractures showed a significant reduction in the time to recommencing full activity (weighted mean difference -33.39 days, 95% confidence interval -44.18 to -22.59 days). These results were highly heterogeneous (I squared = 90%), which is likely to reflect the underlying differences of the trials, including differences in the control group interventions and definitions of outcomes. The use of shock absorbing inserts in footwear probably reduces the incidence of stress fractures in military personnel. There is insufficient evidence to determine the best design of such inserts but comfort and tolerability should be considered. Rehabilitation after tibial stress fracture may be aided by the use of pneumatic bracing but more evidence is required to confirm this.

Comparisons of the joint moments between leading and trailing limb in young adults when stepping over obstacles

Twenty young healthy adults walked and crossed obstacles of heights of 10%, 20% and 30% of their leg lengths and kinematics and kinetics of their gait analysed. Three-dimensional joint moments of the lower limb were calculated with inverse dynamics analysis. Peak moments and crossing moments (joint moments at the time when the swing foot is above the obstacle) were obtained. Most of the peak moments of the supporting limb joints did not show the same height effects as the corresponding crossing moment components. This suggests that the true effects of obstacle heights on the joint kinetics during obstacle crossing cannot be obtained solely through comparisons of peak moments. For inter-limb comparisons the peak and crossing moments were different, suggesting that the leading and trailing limb adopted different kinetic strategies during obstacle crossing. The findings may help to shed light on further investigation on the motor control strategies of the central nervous system for obstacle crossing.

Trichostasis spinulosa: itchy follicular papules in young adults

Trichostasis spinulosa is a common inapparent follicular disorder of retained bundles of vellus hairs. There exist two variants: the classical variant presenting with a non-itching, comedo-like lesion on the face in the elderly, and the pruritic variant presenting with itching, follicular papules located on the limbs in young adults. Here we present the microscopic study of the pruritic variant of trichostasis spinulosa in two patients and provide a review of the literature.

Resultados de la revascularización de miembros inferiores en el paciente arteriosclerótico joven

The most significant recent series on revascularization of the lower limbs in young adults are reviewed. The series that have been published are analysed from the methodological point of view and by examining the results, according to clinical presentation (claudication as opposedto critical ischemia) and the sector which under went the intervention. The papers published, most of which are retrospective series, do not match the commonly accepted standards of publication and this means the information available is even more limited. Nevertheless, the results of revascularization in this population (eventually asymptomatic patients, reintervention, amputation and death rates) appear to be well below those obtained in the population as a whole. Conclusions. Revascularization techniques shouldbe appliedon a very restricted basis in the case of young adults who are carriers of intermittent claudication. Objetivos. Se revisan las series recientes más significativas sobre revascularización de miembros inferiores en el adulto joven. Se analizan las series publicadas desde el punto de vista metodológico y de sus resultados, en función de clínica de presentación (claudicación frente a isquemia crítica) y sector intervenido. Los artículos publicados, en su mayoría series retrospectivas, no se ajustan a los estándares de publicación comúnmente aceptados, lo que limita todavía más la información disponible. No obstante, los resultados de la revascularización en esta población (asintomáticos finales y tasas de reintervenciones, amputación y muerte) parecen muy inferiores a los obtenidos en la población general. Las técnicas de revascularización deberían tener una aplicación muy restringida en adultos jóvenes portadores de claudicación intermitente. São revistas as séries recentes mais significativas sobre revascularização dos membros inferiores no adulto jovem. São analisadas as séries publicadas sob o ponto de vista metodológico e dos seus resultados, emfunção da sintomatologia de apresentação (claudicação face a isquemia crítica) e sector de intervenção. Os artigos publicados, na sua maioria, séries retrospectivas, não se ajustam aos padrões de publicação habitualmente aceites, o que limita ainda mais a informacao disponível. No entanto, os resultados da revascularização nestapopulação (assintomáticos finais e índices de intervenção, amputação e morte) parecem muito inferiores aos obtidos na população em geral. As técnicas de revascularização deveriam ter uma aplicação muito restrita em adultos jovens portadores de claudicação intermitente.

Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults.

Stress reaction in bone, which may proceed to a fracture, is a significant problem in military recruits and in athletes, particularly long distance runners. To evaluate the evidence from controlled trials of treatments and programmes for prevention or management of lower limb stress fractures and stress reactions of bone in active young adults. We searched the Cochrane Musculoskeletal Injuries Group Trials Register, The Cochrane Library, MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, Index to UK Theses and the bibliographies of identified articles. Date of last search: December 1997 Any randomised or quasi-randomised trial evaluating a programme or treatment to prevent or treat lower limb stress reactions of bone or stress fractures in active young adults. Searching, a decision on inclusion or exclusion, methodological assessment, and data extraction were carried out according to a predetermined protocol included in the body of the review. Analysis using Review Manager software allowed pooling of data and calculation of Peto odds ratios and absolute risk reductions, each with 95% confidence intervals. The use of "shock absorbing" insoles, evaluated in four trials, appears to reduce the incidence of stress fractures and stress reactions of bone (Peto odds ratio 0.47, 95% confidence interval 0. 30 to 0.76). Incomplete data from one trial indicated that reduction of running and jumping intensity may also be effective. The use of pneumatic braces in the rehabilitation of tibial stress fractures significantly reduces the time to recommencing training (weighted mean difference -42.6 days, 95% confidence interval -55.8 to -29.4 days). The use of shock absorbing insoles in footwear reduces the incidence of stress fractures in athletes and military personnel. Rehabilitation after tibial stress fracture is aided by the use of pneumatic bracing.

Stepping over an obstacle increases the motions and moments of the joints of the trailing limb in young adults

Tripping over obstacles is the most frequently mentioned causes of falls. Thus, this study was performed to test the hypotheses that when crossing obstacles, toe-obstacle clearance and the three-dimensional motions and moments at the hip, knee, and ankle of the trailing limb (limb crossing the obstacle last) increase with obstacle height. Data were collected using an optoclectronic digitizing system and force platform. Fourteen healthy young adults were tested during unobstructed level walking and when stepping over obstacles of 51, 102, 153, or 204 mm heights. Toe-obstacle clearances of the trailing foot increased from 31 mm during unobstructed gait to an average of 146 mm when stepping over obstacles of any of these heights. Obstacle height was not found to affect toe-obstacle clearance. When the toe of the trailing limb was over the obstacle, the flexion angles of the hip and knee increased linearly with obstacle height. Compared to flexion of the hip or ankle, flexion of the knee appears to be of primary importance when crossing obstacles with the trailing limb. The maximum extension moment at the hip joint during late stance decreased linearly with obstacle height. At the knee joint, the maximum flexion moment during early stance and the maximum adduction moment during late stance increased linearly with obstacle height. At the ankle joint, the maximum dorsiflexion moment during late stance increased linearly with obstacle height. These greater demands on motions and moments may affect the abilities of those elderly having decreased muscle strengths to step over obstacles.

Results of vascular reconstructions for atherosclerotic arterial occlusive disease of the lower limbs in young adults

To evaluate early and long-term results of vascular reconstructions for arterial atherosclerotic occlusive disease (AOD) of the lower limb in young patients under the age of 40 years. Retrospective study. University hospital. Twenty-nine young adults, who underwent vascular reconstruction for histologically proven AOD of the aortoiliac and/or femoropopliteal segments in a 15-year period. Early and late mortality, failure of vascular reconstructions, additional procedures, other manifestations of atherosclerosis, recurrence of symptoms. Nine patients (31%) died, seven related to atherosclerotic disease. In 21 patients (72%) initial vascular reconstruction(s) failed. Twenty-two patients (76%) underwent surgery for failures and/or progression of AOD in other segments of the lower limb. Amputation was performed in five patients (17%). At the end of the follow-up period only 25% of surviving patients were asymptomatic. Young patients undergoing vascular reconstructions for AOD of the lower limbs, in particular those who initially have extensive and progressive atherosclerosis, have a poor outcome in terms of a high mortality and a high operative failure rate. A liberal attitude towards reconstructive surgery, particularly in claudication, is not warranted.

Acute dysvascular limb in a young adult. A case study

Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. Suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.

Primary synovial sarcoma of the middle ear

Synovial sarcoma is a soft tissue malignancy which most commonly affects the lower limbs of young adults and rarely occurs in the head and neck region. The term synovial sarcoma may be a misnomer as most of these tumours occur in tissues not known to contain synovial tissue. There has only been one previously reported case affecting the middle ear, which was metastatic, and we report the first case of primary synovial sarcoma of the middle ear.

Long-term results after arterial surgery for arteriosclerosis of the lower limbs in young adults

Ninety-nine patients, with a mean age of 40 years, underwent surgery for arteriosclerosis of the lower limbs during 1975-81. The main indication for surgery was claudication and the median observation time 102 months (range 54-138 months). Twenty patients died during the follow-up period and fifteen of these could be related to arteriosclerotic disease. At follow-up, 43 patients had claudication, while 34 patients had developed other arteriosclerotic manifestations. Amputation was performed in 17 patients. At follow-up the number of patients at work remained almost unchanged, whereas the number of patients receiving disablement pension increased. This study shows that younger patients with arteriosclerosis of the lower limbs had a mortality of approximately 20%, during the period of observation of this study. However, many patients became asymptomatic after surgery suggesting that a conservative attitude to arterial surgery in these patients cannot be justified.

Effect of intense physical activity on the bone-mineral content in the lower limbs of young adults.

Effect of intense physical activity on the bone-mineral content in the lower limbs of young adults.