1/20. Multicore myopathy: respiratory failure and paraspinal muscle contractures are important complications.Three ambulant males with multicore myopathy, a rare congenital myopathy, are reported with nocturnal hypoventilation progressing to respiratory failure at the age of 9, 13, and 21 years. Deterioration in these individuals occurred over several months without any precipitating event. patients had clinical evidence of nocturnal hypoventilation with hypoxaemia and hypercapnia. Forced vital capacity was significantly reduced (20 to 43% of predicted level). These parameters improved on institution of overnight ventilation using a BiPAP pressure support ventilator with face mask or nasal pillows with O2 saturation maintained above 90% overnight and an increase in forced vital capacity by as much as 100% (0.3 to 0.6 litres). This was matched by a symptomatic and functional improvement. Also present in these patients and not previously reported is the association of multicore myopathy with paraspinal contractures which produce a characteristic scoliosis described as a 'side-sliding' spine. This may be improved by spinal bracing or surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/20. spinal cord injury in children.The spinal injured child has speical needs owing to the processes of physical, mental and social growth. goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/20. pulmonary embolism after minor elective orthopedic procedure.The occurrence of pulmonary embolism, in spite of thromboprophylaxis after a minor elective orthopedic surgery (release of m. rectus femoris tendon) is reported. In case of this severe complication, an early diagnosis is of outmost importance to enable optimal therapy introduction. Deep vein thrombosis and pulmonary embolism are frequent complications after total joint replacement, however, they may also develop after minor surgical orthopedic procedures. The possible causes of pulmonary embolism after release of m. rectus femoris tendon included the history of varicose veins and sclerozation of calf veins, and operative procedure with intraoperative pressure upon large veins of the iliofemoral region, which may and is expected to occur during this procedure. The importance of thrombopropylaxis in orthopedic surgical procedures is emphasized by this case presentation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/20. Choroidal effusion and hypotony caused by severe anterior lens capsule contraction following cataract surgery.PURPOSE: The case report describes a case of severe anterior capsular contraction associated with choroidal effusion. CASE REPORT: An 81 year old female with primary open angle glaucoma underwent routine phacoemulsification cataract surgery. Eight weeks following surgery the anterior capsule opening had reduced to 3 mm in size. intraocular pressure was found to be 4 mmHg and B scan ultrasound revealed a large choroidal effusion. Anterior capsulotomy with Nd:YAG laser was performed. At review, two weeks later, the choroidal effusion had resolved and visual acuity had recovered. DISCUSSION: The Nd:YAG laser radial relaxing capsulotomies helped relieve the capsular contraction and associated traction on the ciliary body.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/20. Ocular findings of Beals syndrome.BACKGROUND: In this report of two Okinawan patients with Beals syndrome and accompanying ocular complications, the symptoms of Beals syndrome and marfan syndrome are compared. The etiology of these two syndromes is considered in relation to fibrillin. CASES: Case 1 was a 5-year-old boy who showed blue sclera and bilateral enlargement of optic disc cupping. Case 2 was a 24-year-old man who had partial coloboma of the lens, mild cataract, and bilateral glaucomatous disc cupping. OBSERVATIONS: Beals syndrome was diagnosed in these two patients based on the initial examination. In further investigations, while the patients were being observed without treatment, the intra ocular pressure of both patients remained within normal range. Funduscopy showed that the cup-to-disc ratio was 0.8 bilaterally in both patients. Case 1 was followed up for 6 years with no changes. Ultrasound biomicroscopy examination in case 2 revealed hypoplasia of the ciliary body, leading to a diagnosis of glaucoma. This patient remains under observation. CONCLUSIONS: Two cases of Beals syndrome with ocular complications including glaucomatous optic disc cupping are reported. Ophthalmic examinations are recommended to identify the ocular complications of Beals syndrome. Further studies are needed to elucidate the relation between fibrillin abnormality and ocular complications in Beals syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/20. Serial casting as a technique to correct burn scar contractures. A case report.Serial casting is a fast, relatively simple, and inexpensive way to effectively correct burn scar contractures. Plaster casts provide circumferential pressure and a prolonged stretch to contracted tissue and cannot be removed by the patient. When casts are applied well and padded appropriately, there is little risk of pressure areas, since the casts are conforming and do not slip distally. Serial casting may be a successful alternative when low-force dynamic splinting cannot be sized small enough for a child, or when patient compliance is unreliable. A case study of a 2-year-old male patient with severe plantar-flexion contractures of the ankles is presented.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/20. rehabilitation of burn patients with concomitant limb amputation: case reports.Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might be expected to lead to chronic difficulties. Therapeutic goals following limb amputation include oedema reduction, prevention of contracture (through positioning and range of motion), stump shaping, both pre- and post-prosthetic fitting strengthening exercises of the limb and trunk, and gait training. Some patients present problems that are associated with both the burn injury and the limb amputation that cause concern among the physical therapy staff. Some of these situations include intolerance of the stump to pressure or manipulation due to remaining open wounds or fragility of newly skin grafted areas on the residual limb or delayed gait or functional training due to wounds on other body surface areas. Delays in stump preparation or other treatment aims due to continued surgical procedures can be worrisome. A review of these patients indicates the possible difficulties that rehabilitation personnel may face when treating burn victims who required amputation. Effective rehabilitation of these patients can be achieved despite the noted concerns.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/20. High-pressure injection of silicone gel into an axilla--a complication of closed compression capsulotomy of the breast. Case report.A case is reported in which a closed compression capsulotomy for fibrous capsular contracture was followed by rupture of the implant bag with the immediate appearance of silicone gel in the axilla. A possible mechanism, analogous to that of high-pressure injection injuries of the hands, is hypothesized.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
9/20. compartment syndromes of the forearm: early recognition using tissue pressure measurements.A compartment syndrome of the forearm can be a devastating injury if not relieved promptly by early fasciotomy. Of five patients who developed compartment syndromes, compartment pressures were measured in four and found to average 69 mm Hg. Tissue pressure measurements provided early objective evidence of the presence of the compartment syndrome and contributed significantly to the ultimate functional recovery. We would advise repeating the measurement for pressures in excess of 30 mm Hg in the upper extremity, and fasciotomy for pressures in excess of 40 mm Hg when accompanied by any neurovascular compromise.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
10/20. Migration of silicone gel after the "squeeze technique" to rupture a contracted breast capsule. Case report.While the squeeze capsulotomy is a simple and effective method for managing capsular contracture around a breast implant, with extreme force the rupture of the prostheses can occur. With the concomitant use of a pressure dressing and breast massage, there was distant migration of the extravasated gel in one case, so this should be considered as a potential complication of this technique.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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