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Journal articles on the topic 'Muscle oedema'
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1
Ray, Aritra Kumar, Poulami Karmakar, Atanu Chandra, Sudip Kumar Ghosh, and Partha Sarathi Karmakar. "Generalised oedema as a presenting manifestation of inflammatory myopathy." BMJ Case Reports 15, no. 3 (March 2022): e248036. http://dx.doi.org/10.1136/bcr-2021-248036.
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Polymyositis is an immune-mediated inflammatory myopathy usually presenting with weakness of proximal muscles in a symmetric pattern. Generalised subcutaneous oedema as presenting feature of inflammatory myopathy, especially polymyositis, has rarely been reported. We report here a case of a young woman who was admitted to our facility with generalised severe subcutaneous oedema. During hospital stay, she gradually developed significant proximal muscle weakness with bulbar symptoms. The initial presentation of the patient masqueraded with other causes of anasarca. However, detailed clinical features, laboratory evaluation, electromyography and muscle biopsy clinched the diagnosis of polymyositis. She was treated with systemic corticosteroids and azathioprine. The patient responded well to treatment and the swelling gradually subsided.
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Gazulla, José, Esteban Mayayo-Sinués, Isabel Benavente, Pedro J. Modrego, and José Berciano. "Ataxia of Charlevoix-Saguenay: MR and Clinical Results in Lower-Limb Musculature." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 41, no. 1 (January 2014): 37–41. http://dx.doi.org/10.1017/s0317167100016231.
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Objective:Peripheral neuropathy is a cardinal manifestation of the autosomal recessive spastic ataxia of Charlevoix- Saguenay (ARSACS), although its type of neuromuscular involvement has not been definitely established, and magnetic resonance imaging (MRI) plays an important role in the assessment of muscle and nerve diseases. The objective of this work has been to define the patterns of muscle weakness and of abnormal muscular MRI in ARSACS.Patients and Methods:Five patients with a molecular diagnosis of ARSACS, aged 39 to 59 years, whose electrophysiological findings were consistent with an axonal neuropathy of distal distribution superimposed on a developmental defect of myelinization, underwent neurological and MRI lower-limb examinations. Conventional FSE T1-weighted and STIR sequences were performed, looking for fatty infiltration and oedema in the musculature of the thighs, legs and feet, together with their distribution along the longitudinal axis of the muscle bellies.Results:On clinical examination, paralysis was apparent in foot muscles; moderate weakness, in leg musculature; and normal strength, in thigh muscles. MRI demonstrated massive fat deposition in the foot muscles and medial gastrocnemii in every case, distal fat infiltration and oedema in every leg muscle group, and preservation of thigh muscles, albeit with diffuse minimal non-specific fat infiltration. An inverse correlation between strength and degree of fat infiltration in lower-limb muscles became apparent.Conclusion:The preponderance of weakness and MRI abnormalities in distal muscle groups was concordant with the presence of a length-dependent axonopathy, as described in ARSACS.
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Glenn-Cox, Sophie, Robert William Foley, John D. Pauling, and Jonathan C. L. Rodrigues. "Fulminant immune-mediated necrotising myopathy (IMNM) mimicking myocardial infarction with non-obstructive coronary arteries (MINOCA)." BMJ Case Reports 13, no. 11 (November 2020): e236603. http://dx.doi.org/10.1136/bcr-2020-236603.
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A 74-year-old man, with inflammatory arthritis, recently commenced on adalimumab, presented with a 4-week history of left-sided chest pain, malaise and shortness of breath. Admission ECG showed age-indeterminate left bundle branch block. Troponin T was 4444 ng/L (normal range <15 ng/L) and acute coronary syndrome treatment was commenced. Catheter angiogram revealed mild-burden non-obstructive coronary disease. Cardiac magnetic resonance (CMR) was performed to refine the differential diagnosis and demonstrated no myocardial oedema or late gadolinium enhancement. Extracardiac review highlighted oedema and enhancement of the left shoulder girdle muscles consistent with acute myositis. Creatine kinase was subsequently measured and significantly elevated at 7386 IU/L (normal range 30–200 IU/L in men). Electrophoresis clarified that this was of predominantly skeletal muscle origin. Myositis protocol MRI revealed florid skeletal muscle oedema. The MR findings, together with positive anti-Scl-70 antibodies, suggested fulminant immune-mediated necrotising myopathy presenting as a rare mimic of myocardial infarction with non-obstructive coronary arteries, diagnosed by careful extracardiac CMR review.
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Sahan, N. T. "PECULIARITIES OF MORPHOFUNCTIONAL CHANGES OF MASTICATORY MUSCLES IN IODINE-DEFICIENT CONDITIONS." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 20, no. 3 (November 12, 2020): 200–204. http://dx.doi.org/10.31718/2077-1096.20.3.200.
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The problem of iodine deficiency is becoming increasingly important in Ukraine. According to the United Nations Children’s Fund (UNICEF), each and all regions of Ukraine suffer from “hidden hunger”. The World Health Assembly has stated that the elimination of iodine deficiency will be as much a triumph for health care system as the eradication of smallpox and poliomyelitis. The goal of this study was to establish the peculiarities of structural organization of the masticatory muscles of rats in experimentally induced iodine deficiency. The research material involved masticatory muscle of 36 white outbred male rats, which were divided into groups: group І – intact animals; group ІІ – kept in iodine deficiency condition; group III – exposed to iodine deficiency with the addition of goitriferous food. All manipulations with test animals were performed in agreement with the regulations on the protection of vertebrate animals. The methods used in the study included: biochemical, histological, histochemical, submicroscopic, morphometric and statistical research methods. It has been established that under the conditions of iodine deficiency the lumen of arterial vessels in masticatory muscles becomes narrowed, the vascular vessels become thickened due to membrane oedema. The number of hemocapillaries per unit area of muscle fibre goes down in all the studied muscles. The number of muscle fibres with intermediate succinate dehydrogenase activity decreases with the simultaneous increase in muscle fibres with low succinate dehydrogenase activity. Furthermore, the oedematous changes are the most prominent in muscle fibres with low succinate dehydrogenase activity. In conditions of iodine deficiency with the addition of goitriferous products, we can observe the progression of luminal narrowing of the artery and wall thickening in masticatory muscles where oedematous-dystrophic changes are considerably marked. There is a tendency in the growth in haemocapillaries number per 1 μm2. Histostructurally, the loss of cross striation is quite noticeable. The cross-section diameter increases, especially in muscle fibres with low succinate dehydrogenase activity and muscle fibres with high succinate dehydrogenase activity in the masticatory muscle proper of immature animals. Ultrastructurally, the oedematous-dystrophic changes of myofibrils and mitochondria were revealed. Thus, under the conditions of iodine deficient diet the lumen of arterial vessels narrows in the masticatory muscles, their wall thickens due to oedema of the membranes, which progresses in iodine deficient diet with the addition of goitriferous products. The number of hemocapillaries per unit area of muscle fibre decreases in both study groups. Changes in vascular bed lead to the redistribution of the number of muscle fibres and their significant oedema.
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Cosgrove, Jeremy, Saira Alli, Hawraman Ramadan, and Helen L. Ford. "Myocarditis and diffuse skeletal muscle oedema: new features of neuromyelitis optica spectrum disorder? A case report." Multiple Sclerosis Journal 20, no. 1 (July 11, 2013): 120–22. http://dx.doi.org/10.1177/1352458513495939.
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We present a case report of newly diagnosed neuromyelitis optica spectrum disorder (NMOSD) with associated myocarditis and diffuse oedema of the pelvic and anterior compartment thigh muscles on magnetic resonance imaging. Aquaporin 4 antibodies are expressed in skeletal myofibres but involvement of skeletal muscle is rarely reported in NMOSD and myocarditis has not previously been described in this context. This case highlights the need for further research into the involvement of cardiac and skeletal muscle in NMOSD.
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Deane, M. N., M. A. Gregory, and M. Mars. "Histological and morphometric changes in untraumatised rabbit skeletal muscle treated with deep transverse friction." South African Journal of Physiotherapy 58, no. 1 (February 28, 2002): 28–33. http://dx.doi.org/10.4102/sajp.v58i1.484.
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Deep transverse friction (DTF) is used in clinical practice and by its nature it may cause muscle injury. This study investigates the morphologic and morphometric changes in untraumatised rabbit skeletal muscle treated with DTF.Method: 16 New Zealand white rabbits were studied. The right vastus lateralis muscle was used as a control and the left vastus lateralis was treated with DTF. Muscle biopsies were taken 10 min, 24 h and 48 h after 1 treatment, 48 h after 2 treatments and 48 h and 6 days after 3 treatments. Treatments were 48 h apart. Biopsies were prepared for light microscopy and tissue morphometry.Results: After 1 DTF treatment, intracellular and extracellular oedema was noted. Contraction bands seen throughout the fibres suggested severe mechanical trauma to the muscle. 48 hours after 1, 2, and 3 treatments, the muscle appeared to be recovering with reduced oedema, and the contraction banding was limited to small focal areas throughout each fibre. Six days after the last treatment, the myofibers, although normal in diameter, showed small focal areas of super contraction and large internalised inclusion bodies composed of a pool of myofilaments or whorls of membranous material. Morphometry showed oedema to be maximal immediately after treatment.Conclusion: DTF causes a severe but reversible injury to untraumatized myofibers. Its possible mode of action in treatment of injured muscle requires further investigation.
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Pinal-Fernandez, Iago, Maria Casal-Dominguez, John A. Carrino, Arash H. Lahouti, Pari Basharat, Jemima Albayda, Julie J. Paik, et al. "Thigh muscle MRI in immune-mediated necrotising myopathy: extensive oedema, early muscle damage and role of anti-SRP autoantibodies as a marker of severity." Annals of the Rheumatic Diseases 76, no. 4 (September 20, 2016): 681–87. http://dx.doi.org/10.1136/annrheumdis-2016-210198.
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ObjectivesThe aims of this study were to define the pattern of muscle involvement in patients with immune-mediated necrotising myopathy (IMNM) relative to those with other inflammatory myopathies and to compare patients with IMNM with different autoantibodies.MethodsAll Johns Hopkins Myositis Longitudinal Cohort subjects with a thigh MRI (tMRI) who fulfilled criteria for IMNM, dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) or clinically amyopathic DM (CADM) were included in the study. Muscles were assessed for intramuscular and fascial oedema, atrophy and fatty replacement. Disease subgroups were compared using univariate and multivariate analyses. Patients with IMNM with anti-signal recognition particle (SRP) autoantibodies were compared with those with IMNM with anti-HMG-CoA reductase (HMGCR) autoantibodies.ResultsThe study included 666 subjects (101 IMNM, 176 PM, 219 DM, 17 CADM and 153 IBM). Compared with DM or PM, IMNM was characterised by a higher proportion of thigh muscles with oedema, atrophy and fatty replacement (p<0.01). Patients with IMNM with anti-SRP had more atrophy (19%, p=0.003) and fatty replacement (18%, p=0.04) than those with anti-HMGCR. In IMNM, muscle abnormalities were especially common in the lateral rotator and gluteal groups. Fascial involvement was most widespread in DM. Fatty replacement of muscle tissue began early during the course of disease in IMNM and the other groups. An optimal combination of tMRI features had only a 55% positive predictive value for diagnosing IMNM.ConclusionsCompared with patients with DM or PM, IMNM is characterised by more widespread muscle involvement. Anti-SRP-positive patients have more severe muscle involvement than anti-HMGCR-positive patients.
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Khiabani, Anvar, Rostad, Stranden, and Kroese. "Verteilung des Ödems von Patienten mit chronischer kritischer Ischämie: Eine computertomographische Studie." Vasa 28, no. 4 (November 1, 1999): 265–70. http://dx.doi.org/10.1024/0301-1526.28.4.265.
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Background: A substantial number of patients with chronic critical limb ischaemia (CLI) have considerable oedema at the distal leg and foot of non deep venous thrombosis origin. The primary aim of the pre-sent study was to quantify the distribution of oedema in the different tissues of the leg and foot by applying computed tomography and planimetry. The interstitial fluid hydrostatic pressure (Pif) in the subcutaneous tissue was measured to evaluate the effect of oedema on local tissue pressure. Patients and methods: Six men and 12 women with unilateral CLI and peripheral pitting oedema were included. Cross sectional areas (CSA) of subcutaneous tissue, muscle and bone were measured by computer tomography combined with planimetry to assess the distribution of oedema within the soft tissues. Pif was measured by “wick-in-needle” technique. Results: The median total CSA of soft tissue, subcutaneous and muscle tissues at the foot level were respectively 17%, 34% and 9% greater in the limbs with CLI compared to the contralateral limb (p < 0.001). At ankle level these differences were 13%, 30% and 4%, respectively (p < 0.001). At the level of the calf these differences were not significant. Mean Pif in the limbs with CLI was 0.3 mmHg, significantly higher than in limbs without CLI (–1.8 mmHg), (p < 0.003). Conclusion: The study verified oedema of considerable magnitude at the ankle and foot. The great part of the oedema was located within the subcutaneous tissue, which was associated with a relatively moderate, but significant increase in Pif confirming the high compliance of the subcutaneous tissue. The combination of the excessive fluid and increased Pif in the interstitial tissue might aggravate the microcirculation. The aetiology of oedema formation is probably multifactorial.
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Aginor, Spanoulis, Yalatia Papastergiou, Panagiota Mitropoulou, and Georgina Burke. "WED 242 A challenging case of periorbital swelling." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A35.2—A35. http://dx.doi.org/10.1136/jnnp-2018-abn.122.
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A 54 year old lady was referred with a eighteen month history of slowly progressive, asymmetric, periorbital and facial oedema. She was thought to have inflammatory orbital pseudotumour.During this time, she had also developed a dry mouth, joint pains and enlarged salivary glands. A salivary gland ultrasound scan was suggestive of Sjogren’s disease although antinuclear antibody and rheumatoid factor were negative. She had recently been prescribed omeprazole for mild dysphagia and hoarse voice from vocal cord oedema.Past medical history included Hashimoto thyroiditis for which she was taking levothyroxine.Clinical examination revealed peri-orbital and facial oedema causing proptosis of the right globe and complete lid closure. Visual acuity, eye movements and visual fields of the left eye were normal. Her voice was hoarse and she had mouth ulcers. She had a widespread erythematous rash that was thought to be a drug reaction to omeprazole.Apart from mild lymphopenia and mildly deranged liver function, blood tests, including inflammatory markers and thyroid function, were unremarkable.MRI of the brain and orbits revealed diffuse oedema of facial structures, including the orbital muscles. A CT body scan was unremarkable.A temporalis muscle biopsy confirmed a high grade NK/T cell lymphoma.
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Braithwaite, B. D., P. V. Petrik, W. S. Moore, H. Gelabert, D. N. Pollen, J. J. Earnshaw, and W. J. Quinones-Baldrich. "Aspirin increases tissue oedema after skeletal muscle ischaemia and reperfusion." European Journal of Vascular and Endovascular Surgery 12, no. 1 (July 1996): 76–80. http://dx.doi.org/10.1016/s1078-5884(96)80279-6.
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Barnes, Matthew J., Dominic Lomiwes, David A. D. Parry, and Stephen Mackintosh. "An experimental model of contusion injury in humans." PLOS ONE 17, no. 11 (November 17, 2022): e0277765. http://dx.doi.org/10.1371/journal.pone.0277765.
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Introduction Contusion injuries are common in sport, but our knowledge of the responses to injury primarily come from animal studies and research using eccentric exercise. Therefore, the aim of this study was to develop a model of contusion injury in human participants and, additionally, investigate and compare physiological responses to four impact loads. Methods Thirty-two males were exposed to a single impact of either 4.2, 5.2, 6.2 or 7.2kg, dropped from 67 cm, on to the vastus lateralis of one leg. Maximum voluntary and electrically induced quadriceps force, and pressure pain threshold were measured, and blood sampling carried out, prior to and 30min, 24, 48 and 72h post-impact. Magnetic resonance imaging was carried out 24h post-impact to quantify oedema. Results Despite impact force with 7.2kg (1681.4 ± 235.6 N) not being different to 6.2kg (1690.7 ± 117.6 N), 7.2kg resulted in greater volume of oedema, voluntary force loss, pain and elevations in creatine kinase than the other loads. Although electrically induced force changed over time, post-hoc analysis failed to identify any changes. Interleukin-6 and prostaglandin-E2 did not change over time for any of the loads. Significant correlations were found between oedema volume, pressure pain threshold and maximum voluntary contraction force. Conclusions This is the first experimental study to investigate traumatic loading of skeletal muscle and the subsequent physiological responses associated with contusion injuries in humans. The absence of immediate elevations in creatine kinase and changes in electrically induced force suggest impact, with forces similar to those experienced in contact sport, does not cause significant, direct damage to skeletal muscle. However, the relationship between oedema volume, changes in pressure pain threshold and maximum voluntary contraction force suggests central inhibition plays a role in contusion-related muscle dysfunction.
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Ochałek, Katarzyna, Aleksandra Frydrych-Szymonik, and Zbigniew Szyguła. "Lower-limb ooedema during pregnancy." Rehabilitacja Medyczna 20, no. 4 (January 31, 2017): 17–21. http://dx.doi.org/10.5604/01.3001.0009.5481.
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Lower-limb oedemas can be the result of abnormalities in the structure and functioning of the lymphatic system, injuries or inflammation, or can be related to cancer and its treatment; however, they are more often one of the basic symptoms accompanying women in the third trimester of pregnancy due to vein insufficiency. The purpose of this overview is to discuss the current knowledge related to risk factors, prevention and treatment of lower-limb oedemas during pregnancy. The risk factors linked to gravidity-related oedema comprise of increased volume of circulating blood, the augmented uterus, increased body mass and changes to hormonal turnover. Vein insufficiency occurs as a result of venous hypertension caused by insufficiency of the muscle pump and valvar regurgitation. Pregnancy, the application of Caesarean section and the postpartum period predispose to deep vein thrombosis (DVT). The basic and unquestionable method applied in the prophylaxis and treatment of abnormalities to the venous-lymphatic system and corresponding complications consists in compression therapy involving compressive bandaging and the use of compression garments. Compression can be applied either individually or in combination with other methods, such as manual lymph drainage, intermittent pump compression and physical or breathing exercises. Based on the scientific evidence and experts’ recommendations, compression is also considered to be an effective solution in the prevention and treatment of deep vein thrombosis and swelling in pregnant women, but further investigation is needed. Ochałek K., Frydrych-Szymonik A., Szyguła Z. Lower-limb oedema during pregnancy. Med Rehabil 2016; 20(4): 17-21. DOI: 10.5604/01.3001.0009.5481
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Pan, Wu, Sara Roccabianca, Marc D. Basson, and Tamara Reid Bush. "Influences of sodium and glycosaminoglycans on skin oedema and the potential for ulceration: a finite-element approach." Royal Society Open Science 6, no. 7 (July 2019): 182076. http://dx.doi.org/10.1098/rsos.182076.
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Venous ulcers are chronic transcutaneous wounds common in the lower legs. They are resistant to healing and have a 78% chance of recurrence within 2 years. It is commonly accepted that venous ulcers are caused by the insufficiency of the calf muscle pump, leading to blood pooling in the lower legs, resulting in inflammation, skin oedema, tissue necrosis and eventually skin ulceration. However, the detailed physiological events by which inflammation contributes to wound formation are poorly understood. We therefore sought to develop a model that simulated the inflammation, using it to determine the internal stresses and pressure on the skin that contribute to venous ulcer formation. A three-layer finite-element skin model (epidermis, dermis and hypodermis) was developed to explore the roles in wound formation of two inflammation identifiers: glycosaminoglycans (GAG) and sodium. A series of parametric studies showed that increased GAG and sodium content led to oedema and increased tissue stresses of 1.5 MPa, which was within the reported range of skin tissue ultimate tensile stress (0.1–40 MPa). These results suggested that both the oedema and increased fluid pressure could reach a threshold for tissue damage and eventual ulcer formation. The models presented here provide insights to the pathological events associated with venous insufficiency, including inflammation, oedema and skin ulceration.
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KNIGHT, Kenneth R., Trixie A. SHINKEL, Peter J. COWAN, Rosalind ROMEO-MEEUW, Anthony J. F. d'APICE, and Wayne A. MORRISON. "Transgenic expression of human complement regulators reduces skeletal muscle ischaemia/reperfusion injury in mice." Clinical Science 108, no. 1 (December 15, 2004): 47–53. http://dx.doi.org/10.1042/cs20040236.
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This study aimed to explore the hypothesis that activated complement components contribute significantly to I/R (ischaemia/reperfusion) injury in skeletal muscle. After 50, 70 and 90 min of tourniquet ischaemia and 24 h of reperfusion, viability of the medial gastrocnemius muscle in CBA-C57BL/6 wild-type mice, assessed histochemically by reduction of NBT (Nitro Blue Tetrazolium) dye, was 60, 21 and 8% respectively. Skeletal muscle viability after 70 min of ischaemia and 24 h of reperfusion in transgenic mice expressing a combination of human CD46, CD55 and CD59, all inhibitors of complement activation, was 45% compared with 24% in ischaemic reperfused wild-type mice (P=0.008; n=6 per group). Muscle from sham-treated transgenic mice and wild-type littermates had no significant loss of viability relative to normal contralateral gastrocnemius muscle. A significant reduction in myeloperoxidase activity (a measure of neutrophil infiltration), xanthine oxidase activity (a source of free radicals) and water content (a measure of oedema) was observed in ischaemic reperfused muscle from transgenic mice compared with ischaemic reperfused wild-type muscle (P<0.05). Haematoxylin and eosin-stained histological sections also showed less damage and less apparent leucocyte infiltration in muscles from ischaemic reperfused transgenic mice than those from wild-type animals given the same degree of injury. Muscles from sham-treated transgenic and wild-type controls were almost identical with normal muscle. It is concluded that complement activation contributes to the pathogenesis of I/R injury in murine skeletal muscle, resulting in increased neutrophil infiltration into the injured muscle, increased free radical production and vascular permeability during reperfusion, and a net detrimental effect on muscle viability.
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Kostic-Mirkovic, Andrijana, Srdjan Pavicevic, Ivan Otasevic, Sergej Radovic, and Tomislav Marenovic. "Papillary muscle head rupture in a patient with normal coronarography findings." Vojnosanitetski pregled 64, no. 4 (2007): 275–78. http://dx.doi.org/10.2298/vsp0704275k.
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Background. Rupture of papillary muscle generally happens during acute myocardial infarction and is the cause of acute mitral regurgitation, pulmonary oedema, so it should be promptly recognized and managed. Case report. A patient, 52 year-old, was admitted to the Thoracic Department with fever, general weakness, dyspnea and cough as a case of suspected pneumonia. Two days before the admission he was treated with antibiotics. At thoracic ward, his clinical status got serious and he transferred to Intensive Care Unit (ICU) as pulmonary oedema. At the time of admission to ICU the patient was seriously ill with tachycardia, tachydyspnea, orthopnea and cyanosis image. Auscultatory, he showed pulmonal stasis at both sides and a tachyarrhythmic action, with a systolic murmur 5/6 grade above the mitral valve. Echocardiography showed grave mitral regurgitation with prolapsus of posterior leaflet with suspected chordal rupture. At coronarography no significant lesions of coronary arteries were found. After hemodynamic stabilization the patient was operated. During the operation, Transesophageal echocardiography (TEE) examination showed a rupture of the head of the posteromedial papillary muscle. He was surgically treated with atypical quadrantectomy of posterior leaflet with homologous pericardial patch anuloplasty. Conclusion. The recognition of acute mitral regurgitation caused by the papillary muscle rupture and prompt surgical treatment is of vital interest for the survival of patients.
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Ginz, H. F., O. Bandschapp, A. Urwyler, T. Girard, and P. A. Iaizzo. "Tissue oedema is not associated with skeletal muscle weakness in septic patients." Acta Anaesthesiologica Scandinavica 54, no. 7 (January 6, 2010): 904. http://dx.doi.org/10.1111/j.1399-6576.2010.02257.x.
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Hauptmann, S., B. Klosterhalfen, J. Weis, C. Mittermayer, and C. J. Kirkpatrick. "Skeletal muscle oedema and muscle fibre necrosis during septic shock. Observations with a porcine septic shock model." Virchows Archiv 424, no. 6 (July 1994): 653–59. http://dx.doi.org/10.1007/bf01069747.
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Senarathne, Udara Dilrukshi, Bolonghoge Krishantha Trixy Priyank Dayanath, Ramani Punchihewa, and Bandu Gunasena. "Patient with respiratory distress, facial oedema and refractory hypokalaemia." BMJ Case Reports 14, no. 5 (May 2021): e240330. http://dx.doi.org/10.1136/bcr-2020-240330.
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Small cell lung carcinoma, when associated with co-occurrence of complications such as paraneoplastic syndrome and superior vena cava syndrome, poses a greater management challenge to the clinical team. We report a 56-year-old man who was eventually diagnosed with stage III small cell lung carcinoma, presenting with respiratory distress, facial and upper body oedema, proximal muscle weakness, hypokalaemia, new-onset hypertension and hyperglycaemia. His medical management was complicated by associated superior vena cava syndrome and Cushing’s syndrome leading to refractory hypokalemia, immunosuppression and depression. Although the patient improved clinically and biochemically with the chemotherapy and other treatments, the development of neutropenic pneumonia led to his demise. This case highlights the importance of a multidisciplinary approach to achieve better patient care and the need for good clinical vigilance to identify possible humoral manifestations of aggressive malignancies such as small cell carcinoma of the lung to assist their early detection.
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Warner, Louise O., J. David Martino, Patricia J. Davidson, and Thomas P. Beach. "Negative pressure pulmonary oedema: a potential hazard of muscle relaxants in awake infants." Canadian Journal of Anaesthesia 37, no. 5 (July 1990): 580–83. http://dx.doi.org/10.1007/bf03006330.
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van de Wouw, Jens, and Jaap A. Joles. "Albumin is an interface between blood plasma and cell membrane, and not just a sponge." Clinical Kidney Journal 15, no. 4 (October 5, 2021): 624–34. http://dx.doi.org/10.1093/ckj/sfab194.
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ABSTRACT Albumin is the most abundant protein in blood plasma and acts as a carrier for many circulating molecules. Hypoalbuminaemia, mostly caused by either renal or liver disease or malnutrition, can perturb vascular homeostasis and is involved in the development of multiple diseases. Here we review four functions of albumin and the consequences of hypoalbuminaemia on vascular homeostasis. (i) Albumin is the main determinant of plasma colloid osmotic pressure. Hypoalbuminaemia was therefore thought to be the main mechanism for oedema in nephrotic syndrome (NS), however, experimental studies showed that intrarenal mechanisms rather than hypoalbuminaemia determine formation and, in particular, maintenance of oedema. (ii) Albumin functions as an interface between lysophosphatidylcholine (LPC) and circulating factors (lipoproteins and erythrocytes) and the endothelium. Consequently, hypoalbuminaemia results in higher LPC levels in lipoproteins and erythrocyte membrane, thereby increasing atherosclerotic properties of low-density lipoprotein and blood viscosity, respectively. Furthermore, albumin dose-dependently restores LPC-induced inhibition of vasodilation. (iii) Hypoalbuminaemia impacts on vascular nitric oxide (NO) signalling by directly increasing NO production in endothelial cells, leading to reduced NO sensitivity of vascular smooth muscle cells. (iv) Lastly, albumin binds free fatty acids (FFAs). FFAs can induce vascular smooth muscle cell apoptosis, uncouple endothelial NO synthase and decrease endothelium-dependent vasodilation. Unbound FFAs can increase the formation of reactive oxygen species by mitochondrial uncoupling in multiple cell types and induce hypertriglyceridemia in NS. In conclusion, albumin acts as an interface in the circulation and hypoalbuminaemia impairs multiple aspects of vascular function that may underlie the association of hypoalbuminaemia with adverse outcomes. However, hypoalbuminaemia is not a key to oedema in NS. These insights have therapeutic implications.
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Lantis, John C., Christopher Barrett, Kara S. Couch, Suzie Ehmann, Emily Greenstein, Marta Ostler, and Anthony Tickner. "A dual compression system: preliminary clinical insights from the US." Journal of Wound Care 29, Sup9 (September 1, 2020): S29—S37. http://dx.doi.org/10.12968/jowc.2020.29.sup9.s29.
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There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.
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Ghaffar, Muhammad Tauseef, Avinash Radhakrishna, Imran Ali, and Byran Whelan. "Statin-induced necrotising autoimmune myopathy: a rare complication of statin therapy." BMJ Case Reports 14, no. 4 (April 2021): e240865. http://dx.doi.org/10.1136/bcr-2020-240865.
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Statin-induced necrotising autoimmune myopathy (SINAM), a rare complication of statin use, presents with significant proximal muscle weakness and raised creatine kinase (CK) levels (50–100 times). This is different from other musculoskeletal conditions caused by statin use. Anti-hydroxy-methyl-glutaryl-coenzyme A reductase (HMG-CoA) reductase antibody is usually positive in SINAM and it generally indicates good response to immunosuppressive medications. We report a case of a 52-year-old man who presented with a 2-month history of significant upper and lower extremity proximal muscle weakness and a CK level of >10 000. He was started on atorvastatin for myocardial infarction 3 years ago. MRI pelvis, including proximal thigh, showed diffuse muscle oedema to all muscle groups. Muscle biopsy was suggestive of necrotising myopathy. His HMG-CoA reductase antibody was also positive. His treatment regimen consisted of immunosuppressants, including steroids. He also required extensive physiotherapy and showed response to treatment when reviewed in the outpatient clinic 9 months later.
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SIMONS, P., P. COLERIDGE SMITH, W. R. LEES, and D. A. MCGROUTHER. "Venous Pumps of The Hand." Journal of Hand Surgery 21, no. 5 (October 1996): 595–99. http://dx.doi.org/10.1016/s0266-7681(96)80137-9.
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Oedema remains one of the most common causes of hand stiffness. Local venous return is intimately associated with oedema formation and management. To elucidate, the underlying mechanisms of venous return, the venous pumping systems in the hand were objectively and quantitatively investigated using Doppler ultrasound, cadaveric dissection and venography. It was demonstrated that functionally there are three independent venous systems: the superficial palmar, deep palmar and dorsal veins, which are activated by palm compression, isometric intrinsic muscle contraction, and dorsum compression, respectively. Each system was investigated independently and found to increase venous blood velocity in both the cephalic and ulnar veins. These systems were also shown to act in synergy, producing the greatest velocity increase when concurrently activated during fist-clenching. The volume of blood pumped during fist-clenching could also be potentiated by preloading by digit abduction. The clinical applications of these findings are discussed.
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Struckmann, Jan R. "Venous Muscle Pump Function following Reconstructive Arterial Surgery." Phlebology: The Journal of Venous Disease 3, no. 3 (September 1988): 169–73. http://dx.doi.org/10.1177/026835558800300307.
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The changes that occur in the leg venous muscle pump function were studied before and after proximal arterial reconstruction in 25 patients with claudication but without rest pain or clinical evidence of venous disease. There was found a significant increase in the distal blood pressure index corresponding to excellent clinical results. The venous muscle pump was affected such that venous return time, RT, decreased significantly ( P < 0.02) but expelled volume, EV, was not significantly affected. It is concluded that these findings may be explained by a postoperative increase in exercise bloodflow and that alterations in RT not only can be caused by changes in venous reflux but also by alterations in arterial input to the leg. The muscle pump capability to pump blood towards the heart was unaffected (EV constant) and it can thus not be incriminated for the postreconstructive oedema often found after arterial surgery. When evaluating isolated RT changes it is necessary to consider whether the arterial input to the pump is constant.
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Almeida, Sara Isabel, Joana Faustino, Rui Duarte Armindo, and Vanessa Mendonça. "Subcutaneous facial emphysema secondary to a dental procedure." BMJ Case Reports 14, no. 9 (September 2021): e242300. http://dx.doi.org/10.1136/bcr-2021-242300.
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Subcutaneous emphysema is a possible but infrequent consequence of dental procedures. We present the case of a 6-year-old healthy boy transferred from a dental clinic immediately after local anaesthesia for tooth extraction, due to sudden orbital and facial swelling. On physical examination, oedema of the left upper eyelid with fine crepitus on palpation and left hemiface oedema with local pain were observed. Ophthalmologic observation was normal. CT scan of the face and orbits documented extensive infiltration of the subcutaneous tissue planes of the left face by air, with extension to the external part of the body of the mandible, retromaxillary fat, masticatory muscle spaces, parapharyngeal space and adjacent to the orbital roof. After completing initial evaluation, the dentist confirmed the use of an air-driven device during local anaesthesia administration. The patient improved with conservative treatment. Early recognition of this condition is essential to provide an adequate clinical assessment with exclusion of possible life-threatening complications.
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Gradner, G., K. M. Hittmair, G. Dupré, B. A. Bockstahler, and M. C. Mueller. "Conservative treatment of partial gastrocnemius muscle avulsions in dogs using therapeutic ultrasound." Veterinary and Comparative Orthopaedics and Traumatology 22, no. 03 (2009): 243–48. http://dx.doi.org/10.3415/vcot-08-07-0059.
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Summary Objectives: In this report two cases of partial gastrocnemius muscle avulsion treated with pulsed therapeutic ultrasound are described. Methods: The outcome in these two dogs was evaluated using ultrasonographic imaging and the measurement of ground reaction forces with a force plate. Results: Both dogs showed an amelioration of the clinical signs within one month after commencement of the ultrasound therapy. The follow-up time for these cases was one year and six months respectively. Both of the dogs were free of lameness and had returned to their normal amount of exercise. Palpation of the fabella associated with the muscle injury did not produce any signs of pain. Ultrasonographic imaging did not detect any signs of haemorrhage or oedema, although scarring of muscle fibres was present. The force-plate analyses revealed an improvement. Clinical significance: These results suggest that therapeutic ultrasound could be a beneficial treatment modality for this kind of muscle injury.
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Hamdan, A.-L., E. Khalifee, H. Jaffal, A. Ghanem, and A. El Hage. "Prevalence of dysphagia in patients with muscle tension dysphonia." Journal of Laryngology & Otology 133, no. 05 (April 5, 2019): 390–93. http://dx.doi.org/10.1017/s0022215119000513.
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AbstractBackgroundIt is hypothesised that patients with muscle tension dysphonia have a high prevalence of dysphagia in comparison to normative values reported in the literature.MethodsThis prospective study included 44 subjects diagnosed with muscle tension dysphonia, based on symptoms and laryngoscopic findings, and 25 control subjects with no history of dysphonia and normal laryngeal examination findings. Demographic data included age, gender and smoking history. The aetiology of muscle tension dysphonia was classified as primary or secondary. Evaluation involved the Eating Assessment Tool (‘EAT-10’) questionnaire.ResultsPatients’ mean age was 45.93 ± 14.95 years, with a female to male ratio of 1.2:1. Fourteen patients had primary muscle tension dysphonia, while 30 had secondary muscle tension dysphonia. Among patients with secondary muscle tension dysphonia, Reinke's oedema was the most common aetiology. There was a significant difference in the prevalence of dysphagia between the study group and the control group (40.9 per cent vs 8 per cent respectively, p < 0.05).ConclusionThis study demonstrates a higher prevalence of dysphagia in patients with the presenting symptom of dysphonia and diagnosed with muscle tension dysphonia in comparison to subjects with no dysphonia.
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Nielsen, Klaus, Jens Kondrup, Lars Martinsen, Birgitte Stilling, and Berit Wikman. "Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis." British Journal of Nutrition 69, no. 3 (May 1993): 665–79. http://dx.doi.org/10.1079/bjn19930068.
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Nutritional assessment and adequacy of spontaneous dietary intake was evaluated in thirty-seven clinically stable hospitalized patients with alcoholic liver cirrhosis. About two-thirds of the patients had ascites or oedema, or both, and, therefore, body weight could not be used for assessment of nutritional status. Lean body mass (LBM; measured by three consecutive 24 h creatinine excretions) was 62 (range 40–95)% of reference values, mid-arm-muscle area (MAMA) was 70 (range 43–115)% and triceps skinfold (TSF) was 45 (range 20–113)% of reference values (all median values). In patients without ascites or oedema, or both, there was a rectilinear correlation between body weight and LBM and between body weight and MAMA (r 0.93 and 0.85 respectively). In patients with ascites or oedema, or both, the correlation between body weight and LBM was poor as could be expected. We suggest that LBM is a useful measure of nutritional status when body weight is unreliable because of ascites or oedema, or both. Energy balance for the group was calculated from energy intake recorded by a 24 h dietary recall and energy expenditure calculated by the factorial method. Median intake was 102 (range 34–176)% of expenditure. N loss was calculated from the average of three 24 h urea excretions. Protein intake was calculated from the 24 h dietary recall. The N balance was positive in the patients as a group (median intake was 120 (range 26–183)% of output). The most malnourished patients tended to have the most positive N balance which was due to a significantly lower N excretion. The protein requirement for N balance was 0.83 (SE 0.05) g/kg per d and only at an intake above 1.20 g/kg per d were all patients in positive N balance. The median intakes of thiamin, folacin, vitamin D, vitamin E, Mg, and Zn were judged to be insufficient. It is concluded that impaired nutritional status is common among patients with liver cirrhosis, even in a stable clinical condition. It is suggested that nutritional status in these patients is evaluated by dietary recalls, in combination with measurement of body weight in patients without ascites or oedema, or both, or in combination with determination of LBM by three 24 h creatinine excretions in patients with ascites or oedema, or both. Criteria for selection of patients that might benefit from nutritional therapy are discussed.
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Persson, Johan, Ulf Ekelund, and Per Olof Grände. "Endogenous Nitric Oxide Reduces Microvascular Permeability and Tissue Oedema during Exercise in Cat Skeletal Muscle." Journal of Vascular Research 40, no. 6 (2003): 538–46. http://dx.doi.org/10.1159/000075677.
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Chimutengwende-Gordon, Mukai, Paul O’Donnell, Nicholas Cullen, and Dishan Singh. "Oedema of the abductor digiti quinti muscle due to subacute denervation: Report of two cases." Foot and Ankle Surgery 20, no. 1 (March 2014): e3-e6. http://dx.doi.org/10.1016/j.fas.2013.09.002.
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Nune, Arvind, Karthikeyan P. Iyengar, Christopher Goddard, and Ashar E. Ahmed. "Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V)." BMJ Case Reports 14, no. 7 (July 2021): e243888. http://dx.doi.org/10.1136/bcr-2021-243888.
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SARS-CoV-2 vaccine roll-out has been successful in the UK and other parts of the world; however, there are increasing concerns about adverse events. A 44-year-old woman presented to a UK hospital with left upper arm pain at the vaccine site a couple of days after receiving the Pfizer-BioNTech mRNA vaccine, which progressed to fever, diarrhoea and abdominal pain over the next few days. She had an erythematous rash on the chest with subcutaneous oedema. Her C reactive protein was 539 mg/L, white cell count of 17×109/L (1.8–7.5), troponin-T of 1013 ng/L and creatine kinase of 572 u/L. She developed an unprovoked pulmonary embolism with acute kidney injury. After administration of intravenous methylprednisolone, the muscle oedema, skin rashes and acute kidney injury resolved. Although multisystem inflammatory syndrome (MIS) is described in children (MIS-C) and adults (MIS-A) following SARS-CoV-2 infection, we highlight the first reported MIS-V case after the SARS-CoV-2 vaccine.
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André, Charles, Marco de O. Py, and Paulo Niemeyer-Filho. "Temporal muscle haematoma as a cause of suboptimal haemicraniectomy: case report." Arquivos de Neuro-Psiquiatria 61, no. 3A (September 2003): 682–86. http://dx.doi.org/10.1590/s0004-282x2003000400030.
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OBJECTIVE: To call attention to an unusual complication of decompressive haemicraniectomy in the treatment of malignant haemispheric infarction. METHOD: We describe a case in which partial decompression occurred despite large craniectomy. Complete decompression followed resection of the temporal muscle. Pertinent literature is briefly reviewed. CASE DESCRIPTION: A 55-year old woman developed massive right middle cerebral artery infarction evolving to cerebral haerniation in 40 hours. Decompressive haemicraniectomy without cortical excision was unable to revert coma and decerebrate posturing because of a massive temporal muscle haemorrhage with persistent contralateral deviation of midline structures. Muscle resection was followed by adequate external haerniation of the affected haemisphere and fast recovery. Cranioplasty was succesfully performed 22 days later, following gradual regression of cerebral oedema. CONCLUSION: There is an increasing perception of the need to operate patients with massive middle cerebral or internal carotid artery territory infarctions before the development of coma and cerebral haerniation. The most common factor leading to inadequate surgical decompression is small size craniectomy. The case reported calls attention to temporal muscle bleeding as an additional complication of craniectomy.
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Kellermann, Marion, Rafael Heiss, Bernd Swoboda, Kolja Gelse, Jürgen Freiwald, Casper Grim, Armin Nagel, Michael Uder, Dane Wildner, and Thilo Hotfiel. "Intramuscular Perfusion Response in Delayed Onset Muscle Soreness (DOMS): A Quantitative Analysis with Contrast-Enhanced Ultrasound (CEUS)." International Journal of Sports Medicine 38, no. 11 (August 10, 2017): 833–41. http://dx.doi.org/10.1055/s-0043-112501.
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AbstractThe purpose of this study was to analyse intramuscular perfusion response in ultrastructural muscle lesions, by applying contrast-enhanced ultrasound (CEUS) to a delayed onset muscle soreness (DOMS) model. Results of this analysis were compared to high-resolution 3 Tesla MRI T2-weighted sequences. 14 healthy participants were recruited. Average perfusion parameters, represented as Peak enhancement (contrast agent inflow) and wash-in area under curve (WiAUC) of the gastrocnemius (GM) and soleus muscle (SM) were assessed before (baseline) and 60 h after inducing DOMS by eccentric exercise. Additionally, conventional ultrasound, high-resolution 3T MRI, creatine kinase level, range of motion (ROM) of the ankle joint, calf circumference and muscle soreness data were collected. Perfusion quantification revealed a statistically significant increase of intramuscular perfusion, corresponding to an increase in peak enhancement of 129.6% (p=0.0031) and in WiAUC of 115.2% (p=0.0107) in the gastrocnemius muscle at post-intervention. At follow-up, the MRI investigations showed intramuscular oedema for GM in all participants corresponding to a significant rise in T2 signal intensity (p=0.001) and in T2 time value (p=0.005). CEUS seems to be able to detect intramuscular perfusion changes and therefore may contribute to gaining deeper insight into the histopathology, inflammatory reactions and regeneration processes of ultrastructural muscle lesions.
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Nenova, Gergana, and Mina Ivelinova. "STUDENT VOLUNTEERISM IN THE REHABILITATION OF A CHILD WITH FRACTURA OLECRANI: PRESENTATION OF CLINICAL CASE." Journal of IMAB - Annual Proceeding (Scientific Papers) 28, no. 3 (August 16, 2022): 4497–500. http://dx.doi.org/10.5272/jimab.2022283.4497.
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Aim: To monitor the rehabilitation progress of a child with fracturaolecrani with the participation of a student volunteer in the multidisciplinary team. Methods: K.J. is an 11-year-old child admitted for rehabilitation in the Clinic of Orthopaedics and Traumatology at University Hospital "St. Marina"- Varna. In 2011 K.J. suffered a fracture in the area of the right elbow joint and underwent surgery with the placement of three Kirschner needles. Four years later, the patient suffered the same fracture and underwent surgery with the placement of two Kirschner needles. Oedema, joint deformation, severely limited range of motion, contractures, muscle hypotrophy and psychotrauma, were found after examination by an orthopaedist and a kinesitherapist. The individual kinesitherapeutic approach is focused on reducing oedema; improving activity; preventing complications; stimulating the patient's participation in social activities. Results: With the help of functional examinations (centimetre measurements, anglemetry and MMT), we established significant restoration of the upper extremity's function and reduction of the oedema. The minimal differences result from the rough operative cicatrix and slight joint deformation. The range of motion is restored to a large extent, as the deficit of 5-10 degrees is not essential in daily activities and could be further restored. Conclusions: the application of an individual approach in the multidisciplinary team's work, with the participation of a student volunteer, helps build a trustworthy relationship with the child patient. The inclusion of a student volunteer in the multidisciplinary team improves communication with vulnerable population groups and contributes to a faster physical and mental recovery.
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IWata, H., M. Hirai, K. Miyazaki, A. Koyama, K. Ikeda, M. Hukiage, and H. Kitamura. "Effect of gaiters on muscle pump activity in healthy volunteers." Phlebology: The Journal of Venous Disease 28, no. 6 (November 30, 2012): 293–98. http://dx.doi.org/10.1258/phleb.2012.012007.
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Objectives: Exercise of the leg with external limb compression has been reported to be useful for preventing and reducing leg oedema. The aim of this study was to investigate the effects of leg gaiters on calf muscle pump activity. Methods: Continuous measurements of the interface pressure at the leg during exercise and determination of the femoral venous velocity at the groin during exercise were carried out in healthy volunteers with elastic stockings alone, leg gaiters alone and gaiters over the elastic stockings. Results: The greatest pressure difference between muscle contraction and relaxation during exercise was observed when gaiters were applied over the elastic stockings at the calf. Gaiters alone without elastic stockings led to a significantly greater pressure difference between muscle contraction and relaxation during exercise than elastic stockings alone (P, 0.01). A significantly higher value of the peak flow velocity of the femoral vein was observed with the combined use of gaiters and elastic stockings than the single use of elastic stockings. Conclusions: Leg gaiters have a beneficial effect of augmenting venous femoral blood flow during calf muscle pump activity in volunteers with a normal valve function of leg veins.
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LIZANO, Sergio, Yamileth ANGULO, Bruno LOMONTE, Jay W. FOX, Gérard LAMBEAU, Michel LAZDUNSKI, and José María GUTIÉRREZ;. "Two phospholipase A2 inhibitors from the plasma of Cerrophidion (Bothrops) godmani which selectively inhibit two different group-II phospholipase A2 myotoxins from its own venom: isolation, molecular cloning and biological properties." Biochemical Journal 346, no. 3 (March 7, 2000): 631–39. http://dx.doi.org/10.1042/bj3460631.
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Myotoxic phospholipases A2 (PLA2s; group II) account for most of the muscle-tissue damage that results from envenomation by viperid snakes. In the venom of the Godman's viper (Cerrophidion godmani, formerly Bothrops godmani), an enzymically active PLA2 (myotoxin I) and an inactive, Lys-49 variant (myotoxin II) induce extensive muscle damage and oedema. In this study, two distinct myotoxin inhibitor proteins of C. godmani, CgMIP-I and CgMIP-II, were purified directly from blood plasma by selective binding to affinity columns containing either myotoxin I or myotoxin II, respectively. Both proteins are glycosylated, acidic (pI = 4) and composed of 20-25-kDa subunits that form oligomers of 110 kDa (CgMIP-I) or 180 kDa (CgMIP-II). In inhibition studies, CgMIP-I specifically neutralized the PLA2 and the myotoxic, oedema-forming and cytolytic activities of myotoxins I, whereas CgMIP-II selectively inhibited the toxic properties of myotoxin II. N-terminal amino acid sequence analysis and sequencing of cDNAs encoding the two inhibitors revealed that CgMIP-I is similar to γ-type inhibitors, which share a pattern of cysteine residues present in the Ly-6 superfamily of proteins, whereas CgMIP-II shares sequence identity with α-type inhibitors that contain carbohydrate-recognition-like domains, also found in C-type lectins and mammalian PLA2 receptors. N-terminal sequencing of myotoxin I revealed a different primary structure from myotoxin II [De Sousa, Morhy, Arni, Ward, Díaz and Gutiérrez (1998) Biochim. Biophys. Acta 1384, 204-208], which provides insight into the nature of such pharmacological specificity.
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Tham, Alexander, Michael McLean, Caroline Atherton, and Neal L. Millar. "Treatment of periscapular tendinopathy with radiofrequency coblation: A case report." SAGE Open Medical Case Reports 8 (January 2020): 2050313X2093061. http://dx.doi.org/10.1177/2050313x20930612.
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Overuse injuries of the tendon – ‘tendinopathy’ – account for 30%–50% of all sporting injuries and a high proportion of orthopaedic referrals from primary care physicians. Tendinopathies often have a multifactorial aetiology and injury can be due to a combination of both acute and chronic trauma which contributes to loss of tissue integrity and eventual rupture. Our incomplete understanding of the mechanisms surrounding tendon pathophysiology continues to cause difficulties in treatments beyond loading regimes which can be unsuccessful in up to 30% of cases. We describe an uncommon case of tendinopathy affecting the periscapular muscle/tendon unit in a 35-year-old female with persistent pain around the inferior posterior pole of her right scapula. Magnetic resonance imaging findings confirmed oedema of the muscles around the inferior scapular margin in keeping with enthesopathy/tendinopathy and she was treated with radiofrequency coblation to the area. This case highlights radiofrequency ablation as a surgical option should non-operative treatments fail in the rare diagnosis of periscapular tendinopathy.
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Reich-Schupke, S., P. Selanski-Porto, P. Altmeyer, M. Stücker, and M. Doerler. "Foot sling for the treatment of diurnal leg oedema: effect due to foot muscle pump stimulation?" Phlebologie 43, no. 02 (March 2014): 84–88. http://dx.doi.org/10.12687/phleb2182-2-2014.
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ZusammenfassungHintergrund und Design: Prospektive Pilot-fallserie zur Beurteilung der Effektivität, Verträglichkeit und Einfachheit der Anwendung einer neuartigen Fußschlinge (Stimfeet) zur Behandlung von habituellen Beinödemen.Patienten und Methoden: Eingeschlossen wurden acht Patientinnen mit nachweisbarer prätibialer Dellenbildung bei habituellen Beinödemen. Hämodynamisch relevante Refluxe oder Obstruktionen der Beinvenen wurden duplexsonographisch ausgeschlossen. Die Patientinnen erhielten eine einwöchige ganztägige Behandlung mit medizinischen Kompressionsstrümpfen (MKS) bis zum Knie (18–23 mmHg) und nach zweitägiger Pause mit Stimfeet (maximal vier Stunden ohne Unterbrechung) oder umgekehrt. Vor und nach jeder Behandlungswoche erfolgten jeweils zwei wasserplethysmographische Volumenmessungen pro Bein. Mittels standardisierter Fragebögen wurden die Effektivität, Verträglichkeit und Einfachheit der Anwendung evaluiert. In einem Patiententagebuch wurden die Nebenwirkungen dokumentiert.Ergebnisse: MKS führten zu einer größeren Volumenreduktion (mittleres Δ rechts: 39,00 g, links: 24,44 g) verglichen mit Stimfeet (mittleres Δ rechts: 5,06 g, links: 2,81 g). Die Ergebnisse unterschieden sich jedoch nicht signifikant (t-test: rechts: p=0,55, links: p=0,63). In Bezug auf weniger Einschränkung (n=5), Komfort (n=6), Reduktion der Symptome (n=5), Verbesserung der Lebensqualität (n=5), Verbesserung der Arbeitsbedingungen (n=5) und den Erwartungen entsprechend (n=5) bevorzugten mehr Patientinnen den MKS. Die Einfachheit der Anwendung wurde gleich bewertet. Die am häufigsten dokumentierten Nebenwirkungen von Stimfeet waren Druck- und Schürfstellen (n=6) und Verrutschen/Notwendigkeit der Fixierung (n=5).Schlussfolgerung: MKS waren der neuartigen Fußschlinge in der Behandlung habitueller Beinödeme überlegen. Bei einer Minderheit der Patientinnen führte die neuartige Fußschlinge jedoch zur Besserung der Beschwerden und Ödemreduktion. Die Wirksamkeit wird möglicherweise durch eine Stimulation der Fußmuskelpumpe bedingt. Methoden zur Aktivierung der Fußmuskelpumpe stellen eine neue Therapieoption für die Behandlung von Beinödemen dar.
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Mars, Maurice, and Michael A. Gregory. "Repeated Compressed Air Massage Treatment Does Not Have An Additive Effect On Treatment Related Muscle Oedema." Medicine & Science in Sports & Exercise 39, Supplement (May 2007): S368. http://dx.doi.org/10.1249/01.mss.0000274445.84252.22.
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Fakhry, Tamer, Hassan Ibrahim Elhaw, and Ahmed Nabil Fawzy. "Comparative study: repair of congenital inguinal hernia with and without opening the inguinal canal." International Surgery Journal 8, no. 2 (January 29, 2021): 459. http://dx.doi.org/10.18203/2349-2902.isj20210087.
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Background: Inguinal herniotomy is the most common surgery performed by paediatric surgeons.Methods: 100 Male and female cases with congenital inguinal hernia aging from one month till the age of two years. randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal oedema and hematoma, and wound infections classified as early complication. The rates of mentioned early complications and operative time were compared in the two interventional groups. In this study, 100 cases were selected and allocated to the two interventional groups.Results: The prevalence of early complications in two studied groups were not different significantly in two interventional groups. Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied techniqueConclusions: The findings of our study indicated that though early complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle both methods are safe and feasible, choosing one of them depend on surgeon prefer.
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Conticini, E., P. Falsetti, M. D’alessandro, S. Grazzini, C. Baldi, M. Bardelli, S. Gentileschi, et al. "POS0871 DIAGNOSTIC ACCURACY OF POWER DOPPLER ULTRASONOGRAPHY FOR THE DIAGNOSIS OF IDIOPATHIC INFLAMMATORY MYOPATHIES." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 730.1–730. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1995.
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BackgroundNo clear-cut guidelines exist about the use of imaging procedures for the diagnosis of idiopathic inflammatory myopathies (IIM). Similarly, conflicting, and scanty data exist about Power Doppler Ultrasonography (PDUS) in this subset of patients. In this regard, we recently proposed (1) a 0-3 grey scale (GS) and Power Doppler (PD) score in a cohort of patients affected by IIM, evidencing a positive, statistically significant, correlation for PD and oedema and disease activity.ObjectivesThe aim of this study was to assess the diagnostic accuracy of our score in IIM patients compared to a control group.MethodsWe prospectively collected, since July 2020 to December 2021, all patients evaluated in Vasculitis and Myositis clinic, Rheumatology Unit, University of Siena, with a recent diagnosis of IIM, as well as patients with a previous, definite diagnosis of IIM and evaluated during follow-up or referred from other centres for a second opinion. As control group, we collected all patients affected by amyopathic dermatomyositis (DM) or who underwent myositis immunoblot or muscle biopsy for proximal limbs weakness but eventually received a diagnosis other than IIM. All patients underwent US examination of both thighs in axial and longitudinal scans.ResultsForty-five IIM patients (11 anti-synthetase syndrome, 20 DM, 12 PM, 2 scleromyositis) and twenty-six controls were included. During the observational period, 7, 8, 1 and 1 patients underwent PDUS twice, three, four and five times, respectivelyAssessing area under the receiver operating characteristic (AUROC) curve analysis, IIM patients and control group were distinguished according to PD sum, Oedema sum, atrophy sum and CRP values (Figure 1a). The best cut-off value for PD sum values was 0.5 (70.2% SE and 83.3% SP), for Oedema sum 1.5 (74.5% SE and 79.2% SP), atrophy sum 0.5 (63.4% SE and 65.4% SP) and CRP was 0.22 mg/dL (61.5% SE and 75% SP).Figure 1.Stratifying IIM population into two groups according to disease activity (PhGA≥2), AUROC curve analysis allow to distinguish these groups according to PD and oedema sum and CRP values (Figure 1b) and the best cut-off values was 1.5 (69.6% SE and 76.9% SP), 2.5 (52.2% SE and 92.3% SP) and 0.55 mg/dL (66.7% SE and 88.9% SP), respectively.Testing the IIM group versus control as dependent variable by logistic regression, with PD sum, oedema sum, atrophy sum, CRP, CPK and myoglobin as independent variables, the AUROC was 0.976. From the probability associated with the Chi-square tests, the Type II analysis showed the variable that most influences the IIM diagnosis was PD sum and oedema sum (p=0.017 and p=0.013, respectively) (Figure 1c).ConclusionGS and PDUS have proven an overall good diagnostic accuracy in distinguishing between IIM and myositis mimicker. In particular, even low values of PD (sum 1.5) display a good sensitivity and specificity and, together with oedema, elevated CRP values and myositis-specific and associated antibodies, may be considered a reliable tool for a definite diagnosis of IIM.References[1]Conticini E, Falsetti P, Al Khayyat SG et al. A novel grey scale and Power Doppler ultrasonographic score for idiopathic inflammatory myopathies: Siena Myositis Ultrasound Grading Scale. Rheumatology (Oxford). 2021 Dec 24;61(1):185-194.Disclosure of InterestsNone declared
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Kruit, Anne Sophie, Dominique van Midden, Marie-Claire Schreinemachers, Erik Koers, Her Zegers, Benno Kusters, Stefan Hummelink, and Dietmar J. O. Ulrich. "Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model." Journal of Clinical Medicine 10, no. 17 (August 27, 2021): 3858. http://dx.doi.org/10.3390/jcm10173858.
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Cold storage remains the clinical standard for composite tissue preservation but is time-limited. A long ischemia time during surgery will adversely affect postoperative outcomes due to ischemia-reperfusion injury. Extracorporeal perfusion (ECP) seems to be a promising alternative for prolonged preservation, but more evidence is needed to support its use and to identify optimal perfusion fluids. This article assessed musculocutaneous flap vitality after prolonged ECP and compared outcomes after replantation to short static cold storage (SCS). Unilateral musculocutaneous rectus abdominis flaps were raised from 15 pigs and preserved by 4 h SCS (n = 5), 18 h mid-thermic ECP with Histidine–Tryptophan–Ketoglutarate (HTK, n = 5) or University of Wisconsin solution (UW, n = 5). Flaps were replanted and observed for 12 h. Skeletal muscle histology was assessed (score 0–12; high scores equal more damage), blood and perfusate samples were collected and weight was recorded as a marker for oedema. Mean histological scores were 4.0 after HTK preservation, 5.6 after UW perfusion and 5.0 after SCS (p = 0.366). Creatinine kinase (CK) was higher after ECP compared to SCS (p < 0.001). No weight increase was observed during UW perfusion, but increased 56% during HTK perfusion. Following 12 h reperfusion, mean weight gain reduced 39% in the HTK group and increased 24% in the UW group and 17% in the SCS group. To conclude, skeletal muscle seemed well preserved after 18 h ECP with HTK or UW perfusion, with comparable histological results to 4 h SCS upon short reperfusion. The high oedema rate during HTK perfusion remains a challenge that needs to be further addressed.
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Grandordy, BM, J. Paiva de Carvalho, J. Regnard, D. Florentin, D. de Lauture, J. Marsac, and A. Lockhart. "The effect of intravenous phenylephrine on airway calibre in asthma." European Respiratory Journal 8, no. 4 (April 1, 1995): 624–31. http://dx.doi.org/10.1183/09031936.95.08040624.
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Tracheobronchial vasoconstriction and subsequent reduction of airway wall thickness due to the alpha 1-agonist methoxamine, might be responsible for prevention of exercise-induced asthma, and reduction of bronchial hyperresponsiveness to methacholine increase in exercise performance in patients with impaired left ventricular function. Since bronchial wall oedema plays an important role in asthma, we have now investigated the bronchial response to the intravenously administered alpha 1-agonist, phenylephrine, in asthma of various severity. Increasing noncumulative intravenous phenylephrine doses (100 to 600 micrograms) were injected in 18 asthmatic subjects (three groups: mild asthma, mild asthma with recent acute attack, severe obstructive asthma) and in 11 control subjects. Changes in specific airways resistance (sRaw) on phenylephrine were linearly related to the dose administered in 16 out of 18 asthmatic subjects, and in only 3 out of 11 control subjects. In the asthmatic subjects, sRaw increased in 10 patients whose asthma was mild, or bronchial obstruction mild to moderate, and decreased in the remaining 8 asthmatic subjects with more severe disease or with a higher degree of bronchial obstruction. Changes in forced expiratory volume in one second (FEV1) were consistent with those of sRaw. In the five asthmatic subjects who underwent the protocol twice, results were reproducible. There was no difference in the responses of heart rate between the three groups of asthmatic subjects. It is likely that phenylephrine acts both via airway smooth muscle contraction, an effect which might predominate in mild asthma, and via mucosal vasoconstriction, which might overcome the effect on smooth muscle in more severe asthma with bronchial wall oedema.(ABSTRACT TRUNCATED AT 250 WORDS)
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De Coster, L., P. Eloy, L. Ferdinande, J. Taildeman, C. A. Cuvelier, and J. B. Watelet. "Different types of tissue composition in inflammatory or reparative upper airway disorders." Rhinology journal 50, no. 4 (December 1, 2012): 393–401. http://dx.doi.org/10.4193/rhino11.164.
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Background: Composition changes of extracellular matrix (ECM) can lead to functional disorders of the upper airways (UA). The aim of this study was to systematically measure both the association patterns and the correlation degree between tissue composition parameters in UA inflammatory diseases. Methodology: Nasal samples were obtained from patients with chronic rhinosinusitis with (CRS+NP), without nasal polyps (CRS), with post-operative adhesions (S) and normal nasal mucosa (NM). A reproducible semi-quantitative method, which takes epithelial and lamina propria damages into account was applied for haematoxylin and eosin, alpha-smooth muscle actin, reticulin, elastin, laminin and collagen type IV stainings. Results: The most severe cases of epithelial shedding have been found in a significant higher amount in CRS+NP when compared with NM. The most severe cases of inflammatory reaction were mainly found in CRS+NP. CRS+NP had significantly more severe cases of oedema than NM. Excluding elastin, networks in other ECM proteins were found modified in fibrotic fields but to a lesser extend in oedematous regions in all conditions. Conclusion: Although non specific, oedema in the lamina propria is a key-feature of CRS+NP, while fibrosis, massively present in CRS and S, affects profoundly the distribution of ECM proteins in these areas.
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Homer-Vanniasinkam, S., and M. J. Gough. "Role of lipid mediators in the pathogenesis of skeletal muscle infarction and oedema during reperfusion after ischaemia." British Journal of Surgery 81, no. 10 (October 1994): 1500–1503. http://dx.doi.org/10.1002/bjs.1800811034.
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Rodrigues Jr, Luiz Fernando, Carla Cristiane Santos Soares, Claudia Rosa de Oliveira, Beatriz Robert Moreira, Mauro Felippe Felix Mediano, and Juliana Rega de Oliveira. "Difficulty in weaning and cardiopulmonary rehabilitation in inoperable severe mitral regurgitation: a case report." Heart, Vessels and Transplantation 2, Issue 3 (August 16, 2018): 74. http://dx.doi.org/10.24969/hvt.2018.73.
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Objective: Severe mitral valve insufficiency may lead to heart failure and associated hemodynamic repercussions, such as congestion and weaning-induced pulmonary oedema. This slows weaning from mechanical ventilation, increases the length of the hospital stay, and worsens the patient’s prognosis. Case report: The present report describes one strategy used for cardiopulmonary rehabilitation and to help wean a patient from mechanical ventilation, with prohibitive comorbidities that contra-indicate surgical mitral valve repair, using respiratory and peripheral muscle training associated with positive pressure ventilation. Discussion: The severe dysfunction of the mitral valve was considered to be surgically inoperable by the surgeon team. However, the weaning and rehabilitation challenges in this patient with severe chronic obstructive pulmonary disease, even with weaning-induced pulmonary edema occurrence, were overcome. The strategy to rehabilitate respiratory muscle force during positive pressure ventilation, concomitantly to a cardiopulmonary rehabilitation program, improved peripheral muscle strength and functionality, reducing energetic demand, allowing the weaning from mechanical ventilation. Conclusion: Despite the severity of the disease, with the adopted strategy it was possible to perform weaning of the mechanical ventilation, allowing the patient to survive with his relatives.
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Zhang, Guoyan, Jichen Li, Qiang Sun, Keyi Zhang, Wenbo Xu, Yong Zhang, and Guizhen Wu. "Pathological Features of Echovirus-11-Associated Brain Damage in Mice Based on RNA-Seq Analysis." Viruses 13, no. 12 (December 10, 2021): 2477. http://dx.doi.org/10.3390/v13122477.
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Echovirus 11 (E11) is a neurotropic virus that occasionally causes fatal neurological diseases in infected children. However, the molecular mechanism underlying the disease and pathological spectrum of E11 infection remains unclear. Therefore, we modelled E11 infection in 2-day-old type I interferon receptor knockout (IFNAR−/−) mice, which are susceptible to enteroviruses, with E11, and identified symptoms consistent with the clinical signs observed in human cases. All organs of infected suckling mice were found to show viral replication and pathological changes; the muscle tissue showed the highest viral replication, whereas the brain and muscle tissues showed the most obvious pathological changes. Brain tissues showed oedema and a large number of dead nerve cells; RNA-Seq analysis of the brain and hindlimb muscle tissues revealed differentially expressed genes to be abundantly enriched in immune response-related pathways, with changes in the Guanylate-binding protein (GBP) and MHC class genes, causing aseptic meningitis-related symptoms. Furthermore, human glioma U251 cell was identified as sensitive target cells for E11 infection. Overall, these results provide new insights into the pathogenesis and progress of aseptic meningitis caused by E11.
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Ravi, Rajesh, Maharajan Athisuyambulingam, Shanmugavel Kanagaraj, Nikola Tresnakova, Federica Impellitteri, Ganapiriya Viswambaran, and Caterina Faggio. "Impact of Chlorpyrifos on Cytopathological Indices in Mangrove Crab, Episesarma tetragonum (Fabricius)." Veterinary Sciences 10, no. 1 (January 12, 2023): 53. http://dx.doi.org/10.3390/vetsci10010053.
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Chlorpyrifos is an organophosphate insecticide occurring in aquatic ecosystems. Due to exposure to xenobiotics, several harmful effects on aquatic organisms are noticed worldwide. Mangrove crabs are an ecologically important aquatic invertebrate species in food web interactions and in the mangrove ecosystem. Therefore, this study aimed to evaluate the cytotoxic effects of chlorpyrifos on the mangrove crab, Episesarma tetragonum. Crabs were exposed to 0.0294 and 0.0588 ppm of chlorpyrifos for 7 and 28 days. Cytopathologic effects on the gill, hepatopancreas, and muscle were investigated, and observations were compared with a control group. The results suggest that chlorpyrifos induces time- and concentration-dependent cytopathological alternations in the gill and exhibited epithelial lifting, oedema, necrosis, and a fusion of secondary lamellae and haemorrhage. The deceased hepatopancreas showed infiltration, a large lumen formation, and the disappearance of haemocytes, while the muscle tissue showed atrophy, necrosis, a wavy appearance, an accumulation of granular material between muscle fibres, and fragmentation in a mangrove crab. This study shows the great potential of cytopathological investigations, allows us to assess the sensitivity of various aquatic animal species to potentially dangerous compounds, and calculates safe concentrations with which to reduce pesticide use.
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Harinesan, Nimalan, and Stephen W. Reddel. "072 Signal recognition particle antibody associated necrotizing myositis with ‘burnt-out’ paravertebral muscle atrophy." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A22.3—A23. http://dx.doi.org/10.1136/jnnp-2019-anzan.60.
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IntroductionNecrotizing autoimmune myositis (NAM) is an increasingly recognised myositis.1 While diagnosis is primarily from muscle pathology, antibodies to signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl–coenzyme A reductase (HMGCR) are also associated.CaseA 67 year old woman presented with proximal weakness and elevated creatine kinase (CK) levels following a complicated AMI, CABG and commencement of atorvastatin. Muscle biopsy confirmed necrotizing myositis and SRP (not HMGCoAR) antibodies were positive. Recovery and rehabilitation was slow and her CK did not normalise for 12 months. She was treated with immunotherapy including intravenous immunoglobulin, oral and intravenous corticosteroids, azathioprine, and mycophenolate.Residual hip, abdominal and truncal weakness remained, affecting her gait and posture. CK levels during this period remained normal. MRI demonstrated extensive paravertebral muscle loss with fatty replacement without oedema. Small myopathic units without active features were present on EMG.ConclusionThis case illustrates several important aspects of NAM, which remains a rare disorder. Recovery can be incomplete in up to 40%, especially if control is delayed.2 In our opinion, normalisation of CK is an important target and may be necessary for full recovery, and rising CK may predict relapse.3 We suggest MRI and EMG of weak muscles may assist in distinguishing persisting myositis from ‘burnt-out’ disease, clarifying whether immunotherapy should be increased or not. However relapse on weaning immunosuppression remains frequent. While SRP antibodies in patients who had also taken statins has been previously reported, the quick sequential onset in this case suggests possible causality.ReferencesMammen AL. Autoimmune Myopathies. Contin Lifelong Learn Neurol. 2016;22(6):1852–1870.Watanabe Y, Uruha A, Suzuki S, et al. Clinical features and prognosis in anti-SRP and anti-HMGCR necrotising myopathy. J Neurol Neurosurg Psychiatry 2016;87(10):1038–1044.Ramanathan S, Langguth D, Hardy TA, et al. Clinical course and treatment of anti-HMGCR antibody–associated necrotizing autoimmune myopathy. Neurol Neuroimmunol Neuroinflammation 2015;2:e96.
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Merchant, Khurshid, Bernard Chern, and Sung Hock Chew. "Cotyledonoid dissecting leiomyoma with intravascular growth pattern and intra-tumoural endometrial glands and stroma: A case report." Case Reports in Clinical Pathology 4, no. 4 (November 9, 2017): 1. http://dx.doi.org/10.5430/crcp.v4n4p1.
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Cotyledonoid dissecting leiomyoma (CDL) is a rare variant of leiomyoma which shows a dissecting growth pattern of smooth muscle cells within the myometrium, with or without extra-uterine extension, and a macroscopic appearance resembling placenta. We present a unique case of CDL with both intravascular growth and presence of endometrial glands and stroma within the tumour. A 35-year-old female patient presented with menorrhagia. Ultrasound examination revealed a bulky anteverted uterus with a prolapsed submucosal leiomyoma and an intramural leiomyoma. In the interest of preserving fertility, she underwent myomectomy together with laparoscopic resections of the uterine wall deposit and myometrial tissue. The tumour was soft and pink, with a resemblance to placental tissue, and histology demonstrated nodules of neoplastic smooth muscle cells with areas of oedema and myxoid change dissecting into the surrounding myometrial tissue, which is consistent with the features of CDL. Also seen were non-neoplastic endometrial glands cuffed by stroma located within the smooth muscle tumour as well as in the non-neoplastic myometrium. There were foci of intravascular luminal growth confirmed by positive CD31 immunohistochemical staining of the endothelial cells lining the vascular lumina. The present case demonstrates that CDLs may have a unique histological appearance resembling adenomyoma and an intravascular growth pattern. It is important for pathologists, gynaecologists and radiologists to recognize such smooth muscle tumour variants and hence prevent misdiagnosis of malignancy and overtreatment.