bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anesthesia (8)
Authors: Casati Andrea , Fanelli Guido , Beccaria Paolo 
Published: September 2010

The effects of the single or multiple injection technique on the onset time of femoral nerve blocks with 0.75% ropivacaine. (University of Milan and IRCCS San Raffaele Hospital, Milan, Italy) Anesth Analg 2000;91:181–184.This study evaluated the effect of the injection technique on the onset time and efficacy of femoral nerve block performed with 0.75% ropivacaine. A total of 30 patients undergoing arthroscopic knee surgery were randomly allocated to receive femoral nerve blocakade with 0.75% ropivacaine by using either a single injection (Single group, n = 15) or multiple injection (Multiple group, n = 15). Nerve blocks were placed by using a short‐beveled, Teflon‐coated, stimulating needle. The stimulation frequency was set at 2 Hz, and the intensity of the stimulating current, initially set at 1 mA, was gradually decreased to <0.5 mA after each muscular twitch was observed. In the Single group, 12 mL of 0.75% ropivacaine was slowly injected, as soon as the first muscular twitch was observed. In the Multiple group, the stimulating needle was inserted and redirected, eliciting each of the following muscular twitches: contraction of vastus medialis, vastus intermedius, and vastus lateralis. At each muscular twitch, 4 mL of the study solution was injected. Placing the block required 4.2 ± 1.7 min in the Multiple group and 3.4 ± 2.2 min in the Single group (P = 0.02). Onset of nerve block required 10 ± 3.7 min in the Multiple group and 30 ± 11 min in the Single group (P < 0.0005). Propofol sedation was never required to complete surgery; although 0.1 mg fentanyl at trocar insertion was required in 2 patients of the Multiple group (13%) and 9 patients of the Single group (60%) (P = 0.02). Conclude that searching for multiple muscular twitches shortened the onset time and improved the quality of femoral nerve block performed with small volumes of 0.75% ropivacaine. Comment by Octavio Calvillo, MD, PhD.This study is concerned with the onset of femoral nerve block utilizing 0.75% ropivacaine in 2 groups of 15 patients undergoing arthroscopic knee surgery. The optimal site for injection was identified by the electrically evoked muscular twitch at the quadriceps. In 1 group, 12 mL of 0.75% ropivacaine was injected as soon as a muscle twitch was evoked. In the second group, 4 mL of local anesthetic was injected only after a specific response was elicited at the vastus medialis, vastus intermedius, and vastus laterallis. Onset of the nerve block required 10 ± 3.7 min. in the multiple injection group, whereas in the single group, onset of the nerve block took 30 ± 11 min. The authors concluded that searching for multiple twitches shortened the surgical anesthesia and improved the quality of neural blockade.
Physical Medicine and Rehabilitation (84)
Authors: Kang Yoon‐Kyoo , Lee Eun‐Ha , Hwang: Miriam 
Published: September 2010

Pure trigeminal motor neuropathy: a case report. (Korea University Medical Center, Guro‐gu, Korea) Arch Phys Med Rehabil 2000;81:995–998.A 38‐year‐old man complaining of progressive weakness and wasting of the right masticatory muscles after a bout of mild cold symptoms is presented in this case report. No sensory symptoms were present. History, neurologic examination, electrophysiologic studies, and magnetic resonance imaging of the brain led to the diagnosis of pure trigeminal motor neuropathy. The cause may have been an autoimmune reaction to a viral infection. Comment by Miles Day, MD.This article is a case report of pure trigeminal motor neuropathy. Trigeminal motor neuropathy is defined as a trigeminal motor paralysis accompanied by no trigeminal sensory signs or other cranial nerve involvement. The author described the history of the patient and their work up including examination, laboratory tests, and electro diagnostic examinations, which all pointed to the pure trigeminal motor neuropathy. The strength of this case report is the detailed description of the anatomy of the trigeminal nerve and the muscular innervations of the mandubular branch. The authors attributed the motor neuropathy to a possible post viral infection autoimmune response that predominantly affected the motor division of the trigeminal nerve. They have stressed that all other potential causes of motor neuropathy should be ruled out including malignancy in mass lesions.
Physical Medicine and Rehabilitation (87)
Authors: Haig A.J. , Yamakawa K. , Hudson: D.M. 
Published: September 2010

Paraspinal electromyography in high lumbar and thoracic lesions. (University of Michigan, Ann Arbor, MI) Am J Phys Med Rehabil 2000;79:336–342.This study aimed to use needle electromyography in the paraspinal muscles to localize the root level of a radiculopathy. Nine cases of clinically proven, isolated high lumbar or thoracic disk herniations of patients who underwent MiniPM were collected. Four were from a prospective study of 114 persons with low back pain (MiniPM had 100% sensitivity to magnetic resonance imaging‐documented high disks). In the most medial “S” column, mean MiniPM scores were 0.7 for the level above the radiologically documented lesion (3.1 at the lesion and 1.6, 1.6, and 1.1 at the 3 spinous processes below the lesion). Similar numbers were obtained in the “M” column (slightly lateral), with no significant differences between S and M. Differences were significant between and at the level of the lesion for S (P < 0.06) and M (P < 0.01), and between the lesion level and 3 levels below for the M column (P < 0.01). Conclude that paraspinal electromyography has a higher than previously reported sensitivity for high lumbar lesions. Electromyography using MiniPM can localize some radiculopathies. The individual cases suggest that, consistent with the anatomy of the caudi equina, thoracic lesions and lateral lumbar lesions denervate only at 1 level, but more central lumbar lesions also denervate distally innervated paraspinal muscles. Comment by Miles Day, MD.This study is designed to assess the sensitivity of many MiniPM for higher‐level rediculopathies, ie, lower thoracic and high lumbar, and to determine if findings are specific to the root level involved. The MiniPM is thought to assess the multifidus portion of the paraspinal muscles that are innervated from L2 to the sacrum. The clinical protocol tests the paraspinal extensively and provides a numerica score, thus eliminating some subjectivity of the EMG. The study demonstrates that MiniPM has good sensitivity for high lumbar and thoracic lesions and provides information on the level of the lesion independent of limb EMG. After reviewing the study, I agree with the authors that MiniPM is in itself not diagnostic for radiculopathy, but is only an additional test to help support other neuro physiological studies when evaluating for radiculopathy. It is not specific for diagnosing radiculopathy.
Physical Medicine and Rehabilitation (90)
Authors: Botwin Kenneth P. , Gruber Robert D. , Bouchlas Constantine G. , Torres‐Ramos Francisco M. , Freeman Ted L. , Slaten: Warren K. 
Published: September 2010

Complications of fluoroscopically guided transformational lumbar epidural injections. (Florida Spine Institute, Clearwater, FL) Arch Phys Med Rehabil 2000;81:1045–1050.This retrospective cohort design study assessed the incidence of complications of fluoroscopically guided lumbar transformational epidural injections at a multidisciplinary spine care center. Patients presenting with radiculopathy caused by either lumbar spinal stenosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning received transformational epidural steroid injections as part of a conservative care treatment plan. All injections were performed consecutively over a 4‐month period by 5 physiatrists. An independent observer reviewed medical charts, which included a 24‐h postprocedure telephone call by an ambulatory surgery center nurse who had asked questions from a standardized questionnaire about complications following the injections. Physician follow‐up office notes 1 to 3 weeks after the injection, along with epiduragrams, were also reviewed. Two hundred seven patients who received 322 injections were reviewed. Complications per injection seen included 10 transient nonpositional headaches that resolved within 24 h (3.1%), 8 increased back pain (2.4%), 2 increased leg pain (0.6%) 4 facial flushing (1.2%), 1 vasovagal reaction (0.3%), 1 increased blood sugar (258 mg/dL) in an insulin‐dependant diabetic (0.3%), and 1 intraoperative hypertension (0.3%). No dural punctures occurred. Conclude there were no major complications. The incidence of minor complication was 9.5% per injection. All reactions resolved without morbidity, and no patient required hospitalization.
Physical Medicine and Rehabilitation (91)
Authors: Petchkrua Wannapha , Harris: Stacy A. 
Published: September 2010

Shoulder pain as an unusual presentation of pneumonia in a stroke patient: a case report. (University of Chicago Hospitals, Chicago, IL) Arch Med Phys Rehabil 2000;81:827–829.An 89‐year‐old woman with right hemiparesis secondary to ischemic lacunar infarction who developed sudden onset of right shoulder pain on the fifth day of inpatient rehabilitation is discussed in this case study. The pain was severe, limiting range of motion (ROM) and participation in therapy. Extensive investigations to rule out subluxation, fracture, connective tissue disease, RSD, and pulmonary embolism were negative. Ultimately, her shoulder pain and decreased ROM completely resolved with antibiotic treatment for right lower lobe pneumonia. Conclude that her symptoms were possibly referred pain from diaphragmatic irritation transmitted via right C4 sensory axons in the phrenic nerve, which shares the same dermatome as the right acromion area. This case was an unusual presentation of pneumonia in an elderly woman with hemiplegia. The authors recommend that pneumonia be considered in differential diagnoses of shoulder pain.
Physical Therapy (93)
Authors: Razmjou Helen , Kramer John F. , Yamada: Riki 
Published: September 2010

Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain. (Sunny Brook & Women's College Health Sciences Centre, Toronto, Ontario, Canada) J Orthop Sports Phys Ther 2000;30:368–389.In this study, patients were assessed simultaneously by 2 physical therapists trained in the McKenzie evaluation system. The therapists were randomly assigned as examiner and observer. Agreement was estimated by Kappa statistics. Forty‐five subjects (47 ± 14 years), composed of 25 women and 20 men with acute, subacute, or chronic low back pain were examined. The agreement between raters for selection of the McKenzie syndromes was K = 0.70, and for the derangement subsyndromes was K = 0.96. Interrater agreement for the presence of lateral shift, relevance of lateral shift, relevance of lateral component, and deformity in the sagittal plane was K = 0.52, 0.85, 0.95, and 1.00, respectively. Intertester agreement on syndrome categories in 17 patients under 55 years of age was excellent with K = 1.00. Conclude that a form of low back evaluation, using patterns of pain response to repeated end range spinal test movements, was highly reliable when performed by 2 properly trained physical therapists. Comment by Karen Crawford, RPT.This article intends to address the ability for therapists to agree on a low back pain diagnosis using the McKenzie technique of classification. It is important for this study to select a clear clinical diagnosis in order to establish rationale for patient management and determine a prognosis. Another purpose for this study was to agree on the relevance of sagittal and frontal plane deformities using McKenzie methods in assessing patients with back pain. The subjects included adult patients with a history of acute, subacute, or chronic low back pain. Patients were referred by general practitioners or specialists for treatment at an outpatient department where the study was conducted. The examination consisted of taking a history, observational evaluation of the range of motion, and completion of a specified tests movements in the sagittal, frontal, and combined planes. Subjects were allowed to communicate only with the assessor. A total of 46 patients with a history of low back pain agreed to complete the assessment. Patients were divided into 2 groups, those 55 years of age and older and those younger than 55. McKenzie identifies only 3 mechanical syndromes: 1. Postural, 2. Dysfunction, 3. Derangement. Each of these syndromes were divided into separate subsyndromes according to location of the pain and presence or absence of spinal deformities. The study concluded that therapists trained in use of the McKenzie evaluation system can be highly reliable in reaching the same conclusion in respect to classifying patients into diagnostic syndromes and subsyndromes, especially in patients under the age of 55. In contrast to other published studies, the importance of advanced training for interpretation of symptom behavior definitely leads to selection of the correct diagnosis.
A Retrospective Study of the Incidence of Neurological Injury after Axillary Brachial Plexus Block
Authors: Ben‐David B. , Barak M. , Katz Y. , Stahl S. 
Published: September 2010

AbstractBackground: It has been suggested that performing a nerve block under general anesthesia, as customary in pediatric population, may predispose to nerve injury. However, few clinical data exist to either support or refute this assertion.Methods: We retrospectively reviewed data on all patients who received an axillary block for upper extremity surgery in our institution during an eight‐year period. The blocks were performed under sedation or general anesthesia, without using a nerve stimulator. Perioperative records from the Hand Surgery Unit Clinic were reviewed for postoperative complaints and complications.Results: In the eight‐year period of the review, 336 patients had axillary block. In total, 230 received the block with sedation and 106 during general anesthesia. All the sedated patients were older than 14 years (mean age 45.2), while of the general anesthesia patients 48 were older than 14 years (mean age 13.9 years). There were six cases of postoperative nerve injury in sedated patients (2.6%) vs. eight cases (7.5%) in the general anesthesia patients. Most patients recovered fully within several weeks. One patient had permanent nerve injury.Conclusions: Definitive conclusions cannot be drawn because of disparities in patient group demographics (majority of pediatric patients were in the general anesthesia group) and the retrospective nature of this study. Nevertheless, the findings suggest that the conduct of axillary block under general anesthesia in pediatric patients holds a greater potential for nerve injury than when the block is performed under sedation in adults.
Ultrasound‐Guided Lumbar Plexus Block for Open Reduction and Internal Fixation of Hip Fracture
Authors: Morimoto Maki , Kim Jung T. , Popovic Jovan , Jain Sudheer , Bekker Alex 
Published: September 2010

AbstractPurpose: Ultrasound technology has been applied to increase both efficacy and safety of certain peripheral nerve blocks. This case report describes the first successful ultrasound‐guided lumber plexus block.Clinical Features: We describe a 91‐year‐old woman with aortic stenosis who successfully underwent open reduction and internal fixation of a fractured right hip with a lumbar plexus block. Ultrasound provided direct visualization to help identify the anatomical structures and guide the block needle during performance of the block. Complete block of the lumbar plexus was attained within 15 min, and the surgical procedure was performed uneventfully.Conclusion: The use of ultrasound has gained popularity to perform peripheral nerve blocks. In this case report, a successful lumbar plexus block was performed with ultrasound guidance. By direct visualization, using this technology may potentially reduce complications associated with lumbar plexus blocks.
Design of Observational Studies edited by P. R. Rosenbaum
Authors: Gilbert Peter B. 
Published: September 2010

Design of Observational Studies(P. R. Rosenbaum)      Peter B. GilbertLongitudinal Data Analysis(G. Fitzmaurice, M. Davidian, G. Verbeke, and G. Molenberghs, Editors)      Joseph W. HoganMultiple Testing Problems in Pharmaceutical Statistics(A. Dmitrienko, A. C. Tamhane, and F. Bretz, Editors)      Jason StoverLife Distributions: Structure of Nonparametric, Semiparametric, and Parametric Families(A. W. Marshall and I. Olkin)      Yosef Rinott
Incidence of Posterior Vessel Wall Puncture During Ultrasound‐guided Vessel Cannulation in a Simulated Model
Authors: Moon Cynthia H. , Blehar David , Shear Michael A. , Uyehara Paradis , Gaspari Romolo J. , Arnold Jeremy , Cukor Jeffrey 
Published: September 2010

AbstractObjectives:  The incidence of posterior vessel wall puncture (PVWP) during central line placement with possible subsequent injury to structures lying behind the vein is unknown. At times the internal jugular vein lies immediately anterior to the carotid artery rather than lateral to it, leading to potential arterial puncture should the needle pass through the vein completely. The objective of this study is to evaluate the incidence of PVWP during simulated ultrasound (US)‐guided vessel cannulation.Methods:  Enrolled subjects were emergency medicine resident and attending physicians. Subjects performed US‐guided venous access on simulated blood vessels within gelatin‐based US phantoms. While blinded to the purpose of the study, each subject performed successful cannulation of the vessel on separate phantoms, with wire placement confirmed by expert review of a follow‐up US. Each phantom was subsequently deconstructed to manually inspect for PVWP.Results:  Thirty‐five subjects with a range of experience in the technique participated, each performing both transverse and long‐axis approaches for a total of 70 cannulations. The overall incidence of PVWP was 34% (95% confidence interval [CI] = 22.9% to 45.1%).Conclusions:  This study found a high incidence of inadvertent PVWP during simulated US‐guided vessel cannulation in this model.ACADEMIC EMERGENCY MEDICINE 2010; 17:1138–1141 © 2010 by the Society for Academic Emergency Medicine
Recurrent erythema multiforme triggered by progesterone sensitivity
Authors: Nasabzadeh Teresa J. , Stefanato Catherine M. , Doole John E. , Radfar Arash , Bhawan Jag , Venna Suraj 
Published: September 2010

Determining the underlying etiology of recurrent erythema multiforme (EM) can be a difficult endeavor. Although infection with herpes simplex virus (HSV) has been implicated in some cases, the precise trigger of a given patient's recurrent EM often remains elusive. We discuss the case of a woman with a recurrent blistering eruption that was clinically and histopathologically consistent with EM. An investigation into the etiology of the patient's EM suggested that HSV was not the causative factor but instead pointed toward a hormonal influence that we interpret as autoimmune progesterone dermatitis (APD). This case is presented to highlight the importance of considering hormonal triggers in women with recurrent EM that consistently flares during the luteal phase of the menstrual cycle, the point at which serum progesterone levels peak. A brief review of the literature regarding the diagnosis, histopathology, etiology and treatment of APD is further provided.Nasabzadeh TJ, Stefanato CM, Doole JE, Radfar A, Bhawan J, Venna S. Recurrent erythema multiforme triggered by progesterone sensitivity.
Facticious disorders in dermatology
Authors: Harth Wolfgang , Taube Klaus‐Michael , Gieler Uwe 
Published: September 2010

SummaryFacticious Disorders are self inflicted skin lesions and includes the creation of physical or psychiatric symptoms in oneself or other reference persons. In dermatology frequently, there are mechanical injuries by pressures, friction, occlusion, biting, cutting, stabbing, thermal burns or self‐inflicted infections with wound‐healing impairment, abscesses, mutilations or damages by acids and other toxic to the skin. The current classification differentiates between four groups: 1. Dermatitis artefacta syndrome in the narrower sense as unconscious/dissociated self‐injury, 2. Dermatitis paraartefacta syndrome: Disorders of impulse control, often as manipulation of an existing specific dermatosis (often semi‐conscious, admitted – self‐injury), 3. Malingering: consciously simulated injuries and diseases to obtain material gain, 4. special forms, such as the Gardner Diamond Syndrome, Münchhausen Syndrome and Münchhausen‐by‐Proxy Syndrome.This categorization is helpful in understanding the different pathogenic mechanisms and the psychodynamics involved, as well as in developing various therapeutic avenues and determining the prognosis.
Diagnosis of cutaneous tumors with in vivo confocal laser scanning microscopy
Authors: Eichert Stefanie , Möhrle Matthias , Breuninger Helmut , Röcken Martin , Garbe Claus , Bauer Jürgen 
Published: September 2010

SummaryIn recent years, in vivo confocal laser scanning microscopy (CLSM) has become an established method for the non‐invasive examination of the skin. In vivo CLSM allows for real‐time imaging of micro‐anatomic cutaneous structures. It has been used to diagnose ambiguous skin tumors and to measure subclinical tumor spread prior to surgery. By additionally providing high power morphologic information, in vivo CLSM helps to reduce unnecessary biopsies. A multitude of diagnostic features for skin tumors has been published. Here we review published diagnostic in vivo CLSM features, and compare them to our own experience in 100 tumors. In combination with clinical examination and dermatoscopy, in vivo CLSM is a valuable additional tool for non‐invasive skin tumor diagnosis.
Adverse drug reactions to biologics
Authors: Scherer Kathrin , Spoerl David , Bircher Andreas J. 
Published: September 2010

SummaryThe use of biologics has rapidly expanded since the introduction of the first diagnostic antibodies; they are now widely employed in oncology, autoimmune disorders, inflammatory diseases and transplantation medicine. Their widespread use has resulted in an increase in adverse drug reactions. Adverse effects result from both direct pharmacological actions and immunological actions, as well as through induction of a specific immune response. The nomenclature, particularly of the monoclonal antibodies, identifies the target structure and organ as well as the species of origin, which then helps predict their effects and antigenic properties. Depending on the extent of foreign protein, anti‐allotypic or anti‐idiotypic antibodies with or without neutralizing properties may be induced. Adverse drug reactions from biologics often depend on the target and may be explained by activation or inhibition of particular cytokine pathways. Adverse drug reactions are classified by their pathomechanism, which enhances understanding of the pathogenesis and facilitates both allergologic diagnostic measures and planning of premedication in future treatments. This review emphasizes immunostimulatory and hypersensitivity reactions.