Calcific tendinitis in the proximal thigh

Calcific tendinitis of the proximal thigh is a benign entity that may cause significant pain. It must be distinguished from chronic or malignant disorders, such as arthritis, infection, and soft tissue/cortical neoplasms. Although it may be self-limited, some patients will benefit from medical intervention. In such cases, we recommend computed tomography-guided percutaneous steroid injection. Herein we describe the clinical and radiographic features of calcific tendinitis of the proximal thigh in 5 patients.     

Multiple methods of personality assessment.

"Multiple personality assessment procedures have been analyzed with respect to their primary purpose and the validation strategy used. Problems that arise in the attempt to use personality assessment for selection were discussed with respect to the problem of clinical versus statistical predictions, the problem of conditional factors that affect the criteria, and the value of using multiple tests and more than one assessor." 42 refs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lymph flow disorders following arterial surgery of the leg

In a series of 342 arterial reconstructions of the iliacolic to popliteal arteries 24 patients with lymph vessel damage were observed. The diagnosis of lymphedema was established in 18 patients by clinical findings and in 2 of them the diagnosis was confirmed by lymphography with followup of 1 year. Three patients developed an internal lymphogenic cyst, 3 showed an external lymph fistula, and 1 patient developed an infection of a dacron bifurcation graft. The infection occurred when an additional occlusion of the left femoral artery was bypassed with an autologous saphenous vein graft and a lymph cyst in the groin, which was excised several times, became infected. The patient was treated successfully by excising the graft and performing an axillofemoral bypass. Although cases of surgical damage to lymph vessels following arterial reconstructions are rare in the literature, it is assumed that this complication occurs more often than reported, because of lack of lymphographic information.     

Multidimensional assessment of perceived treatment-entry pressures among substance abusers.

Motivational assessment instruments typically measure clients' attributions about their readiness to change problem behaviors. They do not indicate why a client may be motivated to change, or provide guidance on how to retain an unmotivated client in treatment. The authors interviewed 415 substance abuse clients about their reasons for entering treatment and scored their responses along the dimensions of (a) negative versus positive treatment-entry pressures, (b) internal versus external sources of those pressures, and (c) the life domain from which the pressures emanated. Exploratory cluster analysis yielded 5 types of clients characterized by different profiles of perceived treatment-entry pressures. Cluster membership was predictive of treatment outcomes, and the clusters differed by demographic variables. These data support the discriminative and predictive utility of performing a multidimensional assessment of pressures to enter treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Open foramen ovale in patients with arterial vascular occlusions of the retina and optic nerve

BACKGROUND: We examined the frequency and significance of persistent foramen ovale (PFO) in patients with ocular circulatory disturbance. PATIENTS AND METHODS: Forty patients with acute arterial occlusions of the posterior bulb segment were investigated by means of transthoracic and transesophageal echocardiography (TEE). The parallel presence of cerebral ischemia was clarified on the basis of existing CCT findings and by additional HMPAO-SPECT investigation. RESULTS: PFO was identified in nine of the patients investigated. The probability of paradoxical embolism arises from further findings: eight of those with PFO (89%) showed echocardiographic signs of right heart strain, indicating previous pulmonary embolism, compared with only three of those without PFO (10%). Five of those with PFO showed a potential source of embolism, two of them with phlebothromboses in their clinical history and three with additional atrial septal aneurysm. Cardiovascular risk factors were prevalent in the group without PFO. Both groups had a mean age of approximately 60 years. Signs of cerebral ischemia were present in the SPECT or CT findings for four of the patients with PFO and nine of those without. CONCLUSIONS: From our findings, it appears highly probable that ocular arterial occlusion is caused by paradoxical embolism. PFO should be taken into account in establishing a diagnosis, including diagnosis in elderly patients.     

Intramuscular pressure in the leg and thigh related to tensile strap force during knee brace wear. An experimental study in man

The role of mitochondria in the energy metabolism of Babesia microti and Babesia rodhaini was investigated. A variety of mitochondrial inhibitors showed greater sensitivity to B. microti than to B. rodhaini. Additionally, alpha-glycerophosphate- and succinate-cytochrome c reductase activities in the crude mitochondrial fraction from B. microti were substantially higher than those from B. rodhaini. Our results suggest that the mitochondria of these parasites possess a series of "classical" apparati for energy production and their relative functional role may be quantitatively greater in B. microti when compared with B. rodhaini.     

Loss of bone in the proximal part of the femur following unstable fractures of the leg

We evaluated the subsequent loss of bone from the proximal part of the ipsilateral and contralateral femora and from the lumbar spine of seven men and nine women who had a fracture of the tibia. The average age was sixty years. All of the fractures were unstable, and the involved leg bore no weight for an average of eight weeks. The bone mineral density was measured with dual-energy x-ray absorptiometry of the lumbar spine and of the femoral neck and the trochanteric region of both hips immediately after the fracture, after the period of immobilization, and at approximately three, six, and twelve months after the fracture. During the period of immobilization, the bone mineral density of the trochanteric region decreased an average of 9 +/- 7 per cent on the side of the fracture, compared with the value immediately after the fracture, but there was no change on the contralateral side (p < 0.01). At twelve months, the average decrease in the trochanteric area was 15 +/- 10 per cent on the side of the fracture, compared with the value immediately after the fracture, but again there had been no change on the uninjured side (p < 0.01). The bone mineral density of the femoral neck on the side of the fracture had decreased 6 +/- 6 per cent at twelve months, compared with a decrease of 2 +/- 4 per cent on the uninjured side (p < 0.05). The bone mineral density of the lumbar spine decreased only during the period of unloading of the fractured leg (1 +/- 2 per cent, p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load

BACKGROUND: Temporal changes in systemic arterial compliance and wave propagation properties (pulsatile arterial load) and their role in ventricular-systemic arterial coupling during gestation have not been explored. Noninvasive methods combined with recently developed mathematical modeling techniques were used to characterize vascular and left ventricular (LV) mechanical adaptations during normal gestation. METHODS AND RESULTS: Fourteen healthy women were studied at each trimester of pregnancy and again postpartum. Experimental measurements included instantaneous aortic pressure (subclavian pulse tracings) and flow (aortic Doppler velocities) and echocardiographic imaging of the LV. A small increase in LV muscle mass and end-diastolic chamber dimension occurred by late gestation, with no significant alterations in myocardial contractility. Cardiac output increased and the steady component of arterial load (total vascular resistance) decreased during pregnancy. Several changes in pulsatile arterial load were noted: Global arterial compliance increased (approximately 30%) during the first trimester and remained elevated thereafter. The magnitude of peripheral wave reflections at the aorta was reduced. The mathematical model-based analysis revealed that peripheral wave reflections at the aorta were delayed and that both conduit and peripheral vessels contributed to the increased arterial compliance. Finally, coordinated changes in the pulsatile arterial load and LV properties were responsible for maintaining the efficiency of LV-to-arterial system energy transfer. CONCLUSIONS: The rapid time course of compliance changes and the involvement of both conduit and peripheral vessels are consistent with reduced vascular tone as being the main underlying mechanism. The pulsatile arterial load alterations during normal pregnancy are adaptive in that they help to accommodate the increased intravascular volume while maintaining the efficiency of ventricular-arterial coupling and diastolic perfusion pressure.     

Calcific tendinitis in the posterior proximal thigh as a self-limited condition: pathogenic role of inflammatory responses

OBJECTIVE: Calcific tendinitis occurs rarely in the posterior proximal thigh. We investigated whether it is self-limited and how the natural course of the disease progresses. METHODS: We treated 6 patients with no surgical intervention, and analyzed laboratory and radiological findings in the followup period of more than one year (average followup, 2.5 yrs). RESULTS: Although tendinitis was severe, rapid relief was observed within 2 weeks (average 5 days). Radiological features including extraskeletal calcifications did not change within 2 weeks, and then improved by 6 weeks. Four of 6 cases showed abnormal laboratory variables. All elevated white blood cell counts and C-reactive protein levels improved within one week with clinical resolution. In comparison with time course of the symptoms, changes in the radiological findings over time appeared not to be parallel with the clinical course, but laboratory progression appeared to correspond well with clinical resolution. CONCLUSION: Inflammatory responses to hydroxyapatite crystals may play a role in the pathogenesis of symptoms of calcific tendinitis in the posterior proximal thigh, most of which are self-limited.     

Multiple assessment of behavior modification with families.

Criticizes the analysis and interpretation of the paper-and-pencil outcome measures used by S. M. Eyberg and S. M. Johnson (see record 1974-32950-001) in a study of behavior modification with families. It is noted that no distinction was made as to which of the 5 measures were needed for a case to be a success and that of the 12 "successful" families, 5 had a negative outcome on 2 of 3 observations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Color duplex ultrasound in the assessment of primary venous leg ulceration

METHODS: To determine the extent and severelity of venous reflux, color duplex ultrasound was used in 370 limbs of 303 patients with primary varicose veins. The clinical findings were classified according to the CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical classification. RESULTS: Of 370 limbs, 32 showed previously healed ulcer (Class 5) and active ulcer (Class 6). Overall reflux in the superficial venous system was seen in 28 limbs (87.5%), and solitary superficial vein incompetence was detected in 13 (40.6%). Reflux was detected throughout the length of the superficial vein system, and the retrograde peak velocity was greater than 30 cm/second in these limbs. Reflux in the perforating veins was detected in 14 limbs (43.8%), but isolated perforating vein incompetence was seen in only one limb (3.1%). Deep vein incompetence was detected in 12 limbs (37.5%). Concomitant superficial and perforating vein reflux was evident in 4 limbs (12.5%) and 2 limbs (6.3%), respectively, but isolated deep vein incompetence was detected in only one limb (3.1%). The operations indicated were selective stripping of the long saphenous vein in the thigh, high ligation of the short saphenous vein, subfascial ligation of perforating veins, and compression sclerotherapy for varicose tributary veins. Healing of the ulcers was achieved within 1 month after surgery, and the postoperative color duplex scanning revealed correction of deep vein incompetence. CONCLUSIONS: These data suggest that ablation of the superficial vein system and the perforating veins is an appropriate method for the management of patients with primary venous leg ulceration.     

A conscious-rabbit model for the long-term observation of urethral and arterial pressures

OBJECTIVE: To describe and evaluate a new experimental model for the simultaneous measurement of urethral (UP) and arterial (AP) pressures in the conscious rabbit, thereby avoiding the interference of anaesthesia which markedly reduces reflex activity and tone of smooth muscle. MATERIALS AND METHODS: Female rabbits were anaesthetized and catheters inserted into the urethra, abdominal aorta, jugular vein and bladder. After recovering from surgery, rabbits were trained to remain static in a sling for a period of 2 h, during which the UP and AP were recorded. The model was validated for short- and long-term stability before the effects of drugs were assessed; UP and AP were recorded for up to 60 min after drug/solvent administration to assess short-term stability, and long-term stability was assessed by comparing 60 min control periods between the first and fifth experimental session up to a month apart. RESULTS: Over 60 min in the control group, the UP remained steady, whereas the AP only decreased slightly. Recordings were made during five subsequent control periods, with at least 3 days of rest between successive assessments, and the UP and AP remained similar for up to 1 month. During a second phase, the effect of alpha 1-adrenoceptor agonists on both pressures were evaluated to characterize their functional uroselectivity. De-glymidodrine and L-phenylephrine (0.1 mg/kg) were administered intravenously; the UP increased by 18 cmH2O (146%) and 21 cmH2O (173%), respectively, whereas AP increased by 22 mmHg (31%) and 47 mmHg (63%), respectively. At 5 min after administering the drugs, the UP remained higher by 16 cmH2O (121%) with de-glymidodrine, whereas it had returned to basal values with L-phenylephrine. CONCLUSIONS: This conscious-animal model allows the simultaneous measurement of UP and AP in the absence of anaesthesia. It provides a useful means to directly evaluate the effects of a drug on the urogenital and cardiovascular systems, and thereby its functional uroselectivity.     

Filling and arterial pressures as determinants of RV stroke volume in the sheep fetus

Right ventricular (RV) function was investigated in nine fetal lambs (125-130 days gestation) that were instrumented with pulmonary artery electromagnetic flow sensors and vascular catheters. Control arterial CO2 and O2 tension, pH, and hematocrit values were 46.1 +/- 1.6 (SD) Torr, 20.6 +/- 1.8 Torr, 7.39 +/- 0.02, and 31 +/- 5.3%, respectively. Control values for right ventricular output (247 +/- 75 ml X min-1 X kg-1), stroke volume (SV, 1.5 +/- 0.4 ml X kg-1), right atrial pressure (3.7 +/- 1.2 mmHg), heart rate (166 +/- 18 beats X min-1), and arterial pressure (AP, 43 +/- 4 mmHg) were unchanged by administration of atropine and propranolol. Withdrawal and infusion of fetal blood with or without concomitant infusion of nitroprusside or phenylephrine produced RV function curves at low, normal, and high arterial pressures. All function curves had a steep ascending limb and a plateau. The breakpoint joining the limbs of the control curve was right atrial pressure 3.4 +/- 1.2 mmHg and SV 1.5 +/- 0.4 ml X kg-1. Increased AP shifted the breakpoint downward. Linear regression of SV on AP from 15 to 95 mmHg at right atrial pressure greater than breakpoint was SV = -0.016 ml X kg-1 mmHg-1 X AP + 2.25 ml X kg-1.     

The arterial supply of the developing proximal end of the human femur

By means of perfusion studies, an analysis was made of the arterial supply to the proximal end of the femur in 150 specimens from autopsied fetuses and children, aged from twenty-six weeks of gestation to fourteen years and eight months old. All died of diseases which did not involve the hip joint. Two anastomotic rings were found: an extracapsular one formed by the medial and lateral femoral circumflex arteries, and a subsynovial intra-articular ring at the articular cartilage-neck junction. The intra-articular rings in males were discontinuous more often than in females. A three-plane analysis of totally-cleared specimens demonstrated that the epiphyseal plate constituted an absolute barrier to blood flow between the epiphysis and metaphysis in all but two of the 124 barium sulphate-perfused specimens examined. A smaller number of ascending cervical arteries crossed the anterior and medial surfaces of the mid-neck in the specimens from three to ten-year-old white children than in those from newborn to two-year-old white and black children. This finding may be important for the etiology of Legg-Perthes disease. No differences with respect to age, sex, or race were found in the arteries of the ligamentum teres.     

Commentary: Reliability and validity of uniqueness scoring in creativity assessment.

Commentary on an article by P. J. Silvia et al. (see record 2008-05954-001) which discusses the topic of divergent thinking. In Study 1, Silvia et al. (2008) criticized the uniqueness scoring of Wallach and Kogan (1965). The uniqueness scoring has a virtue that single rater may be enough to rate, and it is characterized by the assignment of points to uncommon responses in a pool of sample's responses. The first criticism for uniqueness scoring is that uniqueness scores increase as a subject produces more responses, resulting in confounding of uniqueness and fluency. The second criticism relates to the ambiguity of statistical rarity pursued by uniqueness scoring in that uniqueness does not guarantee creativity. When a mundane unique response is misperceived as creative, reliability is threatened. Some bizarre, grotesque, or inappropriate responses in the pool of responses may be assigned a point, causing the validity to be threatened. The third criticism raised by the authors is that the uniqueness scoring system penalizes large samples in that it is less probable for a response in a larger sample of people to appear unique. However, the subjective scoring system has other deficits and is never free from the first two criticisms. The third criticism is, however unfounded; rather, the uniqueness scoring system is in a better position to capture the construct of creativity through better accessibility to large samples. The authors' (Silvia et al., 2008) three criticisms will be discussed one by one. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significance of arterial anastomoses of the distal calf and proximal foot for compensation of peripheral arterial occlusive disease

One hundred and one patients with metastatic melanoma were treated with three different dacarbazine (DTIC)-based polychemotherapy plus recombinant interferon (IFN) alpha-2b regimens in multicentre phase II trials in Finland during 1986-1993. The regimens were DTIC, nimustine (ACNU) plus IFN and two different schedules of DTIC, vincristine, bleomycin, lomustine (CCNU) plus IFN. There were 14 patients with complete response (CR) and 12 patients with partial response, with estimated median survivals of 44 months and 13 months respectively. The median survival was 14 months for 22 patients with stable disease, and 6 months for the 53 patients who had progressive or non-evaluable disease. The median progression-free interval was 6 months and the median survival 9 months for the whole group. Thirty-nine percent of patients survived at least 1 year and 17% at least 2 years. Age, sex, primary tumour site, Clark's level, disease-free interval, prior therapy of recurrence and metastatic sites of patients who achieved CR were compared with those of other patients. In addition, the predictive value of these factors for survival was analysed. Prior therapy of recurrent disease (none, surgery or surgery plus radiotherapy) and metastatic profile (soft tissue or lung, one or two sites) were associated with CR in univariate analysis, while in multivariate analysis only prior therapy was found to be an independent prognostic factor. Prior surgery plus radiotherapy, soft tissue or lung metastases and response to present chemo-immunotherapy were significant predictors of favourable survival in univariate analysis. In multivariate analysis only response was an independent prognostic factor.