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Am J Respir Crit Care Med 2003; release purchase 12.5 mg hyzaar with mastercard, together with that of apoptotic factors hyzaar 12.5 mg with amex, may under- 167:418–424 lie the emphysema and buy hyzaar 50mg without prescription, conversely, fibrosis of the small air- This article explores the differences in airway inflamma- ways may be accounted for by the effects of growth factor tion in a cohort of older patients (age 65) with fixed airflow activation. Subjects with tial factors include the development of autoimmunity, with asthma had significantly more eosinophils in peripheral activation of dendritic cells and T-helper cells. Although these tion, long-term oxygen therapy, surgery, and noninvasive distinctions are important from a research point of view, the ventilation strategies. Outcomes high expense of the testing, lack of availability of these tests, following acute exacerbation of severe chronic obstruc- and finally the fact that the tests are not always discrimina- tive lung disease. This five-center study This study evaluated the cardiovascular safety of salmeterol described the outcomes of patients hospitalized with an from a pooled analysis of safety data from 17 studies. Am J Respir Crit utable to lifestyle, genetics, treatment with corticosteroids, Care Med 2001; 164:1002–1007 endocrine abnormalities, or the impairment of the body This group measured the risk factors for exacerbations of composition and peripheral skeletal muscles. The effi- Chest 2001; 120:258–270 cacy and safety of fluticasone propionate (250 g)/sal- This is a review of the nonbronchodilating effects of long- meterol (50 g) combined in the diskus inhaler for the acting agonists. Chest 2003; 124:834–843 adherence of bacteria to the epithelium, capillary leak, mucus These investigators show that treatment with fluticasone clearance, and inflammatory mediator release. It offers a rea- and salmeterol delivered by the diskus device and given twice son for use of long-acting beta agonists in addition to their daily improved lung function when compared with either of bronchodilating properties. Randomized tify new therapeutic targets for the development of novel controlled trials did not find improved gas exchange; lung drugs for the prevention and treatment of exacerbations. Sixty-three percent of patients with low lung bilitation relieves dyspnea and fatigue, improves emotional function had no previous or current reported diagnosis of function, and enhances patients’ sense of control over their any obstructive lung disease. Effect of 232 oxygen on health quality of life in patients with chronic This older article reminds us of the advantages of using the- obstructive pulmonary disease. However, 2 of the 27 patients showed very low carbon monoxide diffusing capacity are at very consistent improvement of dyspnea measured on the Chronic high risk of death after surgery. Dynamic hyperin- for the diagnosis, management, and prevention of flation and exercise intolerance in chronic obstructive chronic obstructive pulmonary disease. N Engl J Med 1999; dynamic hyperinflation curtails the tidal volume response to 340:1941–1947 exercise, it was thought that this was an important factor This article received a great deal of press. The risk of obstructive pulmonary disease on general respiratory type 2 diabetes was significantly greater for patients with wards: a multicentre randomised controlled trial. Proc Am Thorac Soc 2005; 2:94–100 This review discusses the unresolved debate about adequate This review discusses the interactions between cardiac and prescription of antibiotics for patients suffering from exac- pulmonary disease. Additional evidence supports with mild-to-moderate exacerbations, antibiotics may not be improvements in health-care utilization and psychosocial generally indicated and the authors felt that further research outcomes. Biopsy neutrophilia, neu- maintenance strategies following rehabilitation, and the trophil chemokine and receptor gene expression in incorporation of education and strength training in pulmo- severe exacerbations of chronic obstructive pulmonary nary rehabilitation are beneficial. Peripheral airways show 973 more inflammatory changes of all cells, including neutro- The risk of a subsequent exacerbation after treatment of an phils in severe disease. Data indicate that when emphysema is severe, loss with a longer time to the next exacerbation, and a decreased of elastic recoil assumes overwhelming importance as a risk of developing a new exacerbation. Cellular and cin was chosen to determine whether regular therapy with structural bases of chronic obstructive pulmonary dis- macrolides reduces exacerbation frequency. The rate ratio for exacerbations for the macro- and macrophages infiltrate the airway wall of the central air- lide-treated patients compared with placebo-treated patients ways, and that neutrophils in the airway wall are increased was 0. Recovery of peak flow rates to baseline values was between chronic obstructive pulmonary disease and comor- complete in only 72% of exacerbations at day 35. Clinical features and The cause of systemic inflammation (as evidenced by bio- prognosis of lifetime non-smokers with severe 1-anti- markers) is not known, but it has been suggested that it is trypsin deficiency. New strains of bac- whether the inhaled corticosteroid (fluticasone) with or with- teria and exacerbations of chronic obstructive pulmo- out a long-acting beta agonist (salmeterol) could reduce blood nary disease. Participants with to a statistically significant level, this did not translate into severe airflow obstruction had a significant increase in a clinically meaningful level for all patients with combi- markers of inflammation, including circulating leukocyte, nation treatment. A lower risk of study withdrawal was platelet, and fibrinogen levels, as well as levels of C-reactive observed in patients administered adjuvant inhaled corti- protein. Lung transplant Med 2009; 169:219–229 outcomes: a review of survival, graft function, physi- Recent studies have suggested a possible association ology, health-related quality of life and cost-effective- between pneumonia and the use of inhaled corticosteroids. Eur Respir J 2004; 24:674–685 The authors performed a systematic search to ascertain the This article reports on the success of lung transplantation risk of pneumonia with long-term inhaled corticosteroid that improved over time. Despite this success, there are mized controlled trials of any inhaled corticosteroid with numerous problems and complications that may develop over at least 24 weeks of follow-up and reporting of pneumonia the life of a lung transplant recipient. Eighteen randomized controlled trials ment for the overall outcomes of lung transplantation will showed that inhaled corticosteroids were associated with a only occur when better methods exist to prevent or effec- significantly increased risk of any pneumonia (relative risk tively treat chronic rejection. Benefits and in lung function, quality of life, and exacerbations during risks of adjunctive inhaled corticosteroids in chronic a 4-year period but did not significantly reduce the rate of obstructive pulmonary disease: a meta-analysis. Effect of statin erbation rates that required treatment with oral corticoste- therapy on mortality in patients with peripheral arte- roids and/or antibiotics, or required hospitalization. There was no consistent clinically or statisti- Investigating New Standards for Prophylaxis in Reduc- cally significant effect on lung function, gas exchange, ing Exacerbations is the first large-scale trial to compare respiratory muscle strength, sleep efficiency, or exercise the clinical outcomes of two frequently used treatments for tolerance with this modality. The authors of this study made this comparison be necessary in the future to approve its usefulness during a 2-year treatment period in a multicenter study conclusively. It is recommended that testing not be performed Key words: interpretation; pulmonary function laboratory; within 1 month of an acute coronary syndrome or pulmonary function testing; quality assurance; spirometry myocardial infarction. A thorough understanding of the span from fingertip to fingertip should be used as indications, conduct, interpretation, and limita- an estimate of height (regression equations are available). Reuseable mouthpieces, valves, mouthpieces, contaminate the results and subsequently lead to and manifolds must be appropriately disin- misinterpretation regarding the patient, disease, fected or sterilized. Sterilizing and disinfecting techniques should Although specific important issues will be dis- be strictly adhered to and should be established cussed in sections to follow and a number of in consultation with the manufacturer’s rec- overall principles deserve highlight, the topic is ommendations and local or hospital infection- reviewed in detail elsewhere. In patients with known or suspected transmis- pressure must be actually recorded, and it is also sible infectious diseases, additional precautions important to ensure accuracy of the instrument should be undertaken. The time of day (a) the use of equipment solely reserved for use should be noted, and serial testing should ideally in this clinical setting; be made at similar times of the day to minimize (b) testing patients at the end of the day to variation. Consideration should also be given rooms with enhanced capabilities (ie, neg- to the effects of bronchodilator administration on ative pressure ventilation, etc). Although some significant differences between suggested order for performing lung function tests measurements with and without filters have been is noted in Table 2. However, because the benefits of evacuation procedures; compressed gas storage filters have not been clearly identified, their use is and use; electrical safety; and procedures and not mandatory, particularly if all other precautions practices for tending to patient urgencies and are strictly followed. Appropriate pro- inline filters, perhaps to reassure patients and staff cedures must be established, understood, and that their safety and protection are a high priority. It deserves emphasis that the use of inline filters Infection control measures are also necessary should not be viewed as a shortcut for appropriate for the protection of patients and staff. Although infection control, and their use does not eliminate the risk of infection is small, the potential is real, the need for regular cleaning and decontamination and the consequences are serious. Suggested Order for Conducting Lung Function Tests* • Spirometry and flow-volume curves All staff must be appropriately trained to • Lung volumes understand the fundamentals of testing, to be • Bronchodilator administration familiar with signs and symptoms of common • Diffusing capacity • Repeat spirometry and flow-volume curves respiratory disease, and to properly execute all aspects of testing. Evaluation and Feedback for Pulmonary Function significant changes in pulmonary function can Laboratory Technicians* occur while values still remain within the normal • Information regarding acceptable maneuvers and nonre- range. These factors serve to complicate the choice producible tests of the most appropriate reference value regression • Specific corrective actions the technicians can undertake to equations to use in the clinical laboratory.

Alkaline diuresis will prevent the precipitation of toxic myoglobin metabolites in nephrons and Staged tourniquet release strategy help ameliorate acidosis and hyperkalaemia order 12.5mg hyzaar with visa. This allows for controlled washout and sys- oedema (particularly in the presence of pre-existing renal or heart temic redistribution of ischaemic metabolites during reperfusion discount hyzaar 50 mg mastercard. The risk of iatrogenic metabolic alkalosis and sodium It should be employed on one limb at a time and the patient overload is greater in the unmonitored prehospital environment must be monitored closely cheap hyzaar 12.5mg otc. If at any point the patient becomes and where possible alkaline diuresis should be left for the hospital unstable, then the tourniquet should be immediately reapplied environment where it can be titrated to urine output, urine pH and and the patient’s cardiovascular state managed prior reinstituting serum pH. Once optimal volume resuscitation has been achievedfurtherhypotensiveepisodesmaybetreatedwithinotropic or vasopressive agent. Tourniquet Released + Re-inflated 30 sec later Tips from the field 3 Min • Resuscitate the system prior to release • Consider use of tourniquets to prevent rescue cardioplegia Tourniquet Released • Limb amputation may be considered in the non-viable limb • Prepare for clinical deterioration after release. Introduction Permanent Cavity The term ballistic trauma encompasses any physical trauma sus- tained from the discharge of arms or munitions. The two main types of ballistic trauma likely to be experienced by prehospital practi- Figure 20. The rise in terrorist activity over the last decade and the increased use of firearms during criminal passage of the projectile the temporary cavity collapses down to acts means such injuries are becoming increasingly common. Cavitation within solid organs such as the liver, kidney and brain leads to massive tissue disruption. By comparison elastic Firearms are weapons designed to expel projectiles at high veloc- tissues such as muscle and lung tissue have the ability to stretch and ity through the confined burning of a propellant. If the projectile Blast injuries encounters a vital structure such as the brain, heart or great vessels Explosive detonation is the rapid chemical transformation of a solid the wound may prove lethal. Under high pressure and temperatures this gas those fired by long-barrelled weapons (e. Air is highly a shockwave which drives tissues radially from the wound track compressed at the leading edge creating a shock front called a blast creating a temporary cavity (Figure 20. When unobstructed the blast wave rapidly loses its pressure forms a vacuum which draws in contamination from outside. The blast wave interacts with body tissues by imparting © 2013 John Wiley & Sons, Ltd. In severe cases, primary blast injury can induce vagally mediated bradycardia, apnoea and hypotension. Survivors in this group are rare as a casualty close enough to an explosion to sustain this level of primary injury will commonly have other lethal injuries (secondary and/or tertiary). Injury type Pathophysiology Clinical Features Blast lung Blast wave damages causes: • Interstitial • Dyspnoea haemorrhage/oedema • Chest pain • Intra-alveolar • Haemoptysis haemorrhage/oedema • Wheeze ◦ Pulmonary oedema • Crepitations ⎧ ⎨Apncea • Parenchymal lacerations • Severe }Bradycardia ◦ ⎩ Pneumothorax Hypotension • Alveolar-venous fistulas ◦ Air embolism Blast bowel Blast wave damage causes: • Bowel Contusion • Abdominal pain • Bowel perforation (may • Malaena be delayed) • Peritonitis • Intra-luminal bleeding • Shock Large bowel > Small bowel Often delayed onset Blast ear Blast wave damage causes: • Rupture of the tympanic • Hearing loss membrane • Ear pain • Ossicle dislocation • Vertigo Figure 20. This is the blast wind and injuries resulting from • Disorientation it are termed tertiary blast injury. Bodies may be thrown against solid objects causing blunt injury, or limbs traumatically amputated (Figure 20. Structural collapse as a result of blast wind may result Blast waves and primary blast injury are seen following det- in crush and blunt trauma from falling debris. Semtex, C-4, ammonium injury is the term given to any other explosion-related injury nitrate fuel oil). Incident management Fragments of the explosive device itself (primary fragments) and other material energized by the blast (secondary fragments) The potential threat to rescuers from active shooters, secondary are projected outwards and may cause penetrating injury. Biological material from victims such as bone may also form projectiles and cause penetrating injury further Personal protective equipment afield. Transmission of blood-borne viruses by this route has been Blast incidents commonly result in hazardous ground debris (e. Dynamic risk assessment Incidents involving firearms and blast are often dynamic in nature. They may involve multiple assailants and/or locations as well as the real risk of follow-up attacks or secondary explosive devices deliber- a respiratory hazard from hanging dust. When attending a firearms or and respiratory protection is therefore essential if deploying to blast incident it is essential to remain observant at all times and not such incidents. When working as part of a prehospital team, release must be considered in all incidents involving blast. When available this in the vicinity of the practitioner the immediate action should be should be applied prior to deployment to the scene of any ballistics to get low and move into hard cover (e. If this is the only available vests with integral high-velocity plates for additional protection cover the engine block and wheels provides the greatest level of against high-velocity rounds. Be aware that assailants themselves may become casualties at blast and firearms incidents. Ensure the police have searched and Approach to scene disarmed all casualties prior to approaching. This includes injured The police are responsible for the control of incidents involving officers who may through injury or fear of further attack lose their firearms and/or blast. Their initial actions will follow the four Cs ability to make rational decisions regarding the discharge of their approach (Box 20. Do not touch objects or disturb the environment except to Clear Clear people away from the threat as quickly as treat patients to avoid contaminating the forensic evidence. Dead practicable bodies should only be disturbed to give access to live casualties. Finally, cordon keep control of your equipment to prevent it being lost to the police forensic team particularly if death is declared on scene. Assess the priority patients with blunt trauma, these tools may under-triage a number before treatment 2. Thecharacteristicphysiological response to blood loss of increasing tachycardia can be less marked Walking? In most situations the Rate level of threat to the rescuer will be low and the full spectrum 10-30/min of prehospital critical care intervention possible. In the event unconscious or over 120/min Write T1 of an unexpected escalation in threat level (e. Catastrophic haemorrhage control Triage Rapidly assess for exsanguinating limb haemorrhage and apply Mass shootings and bomb blasts often result in multiple casualties. The time of application should be Initial triage should be performed using a simple triage tool such noted. Trauma: Ballistic and Blast 107 tourniquet above the first particularly on proximal limb injuries own airway and drain secretions and blood. Patients presenting in traumatic cardiac arrest position should be maintained during transfer to a facility capable or in a peri-arrest state with critical hypovolaemia following sig- of fibreoptic intubation and/or surgical tracheostomy. Patients nificant limb trauma should have tourniquets applied even in should not be forced to lie supine. Obtunded or unconscious the absence of active bleeding as rebleeding is common with patients with significant facial bleeding and pooling of secretions resuscitation and/or movement during packaging. Where transfer distances are short and the patient’s injuries dressings and direct pressure. In cases where transfer time, persistent obstruction or other injuries dictate Airway management further airway intervention, the location and severity of injury will Penetrating injury or blast trauma to the face or neck may result in determine the type of intervention selected (Figure 20.

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Infection is either blood borne or the direct result of a traumatic wound or surgery purchase hyzaar. Infective spondylitis buy hyzaar paypal, both acute and chronic purchase hyzaar 50mg without prescription, produces the characteristic ‘sandwich’ sign on magnified scintigraphs. This sign consists of intense tracer uptake in two apposing end-plates with narrowed disc space. Pathologically, bone tuberculosis is characterized by destruction with relatively mild reactive bone formation. A special form of tuberculosis, which involves the finger in infants, is known as spina ventosa. Planar bone scan findings are usually not specific, but pinhole scinti- graphy reveals findings of diagnostic value. The diseased bone shows a localized area of increased tracer uptake, occasionally with associated photopenic area(s). In the spine, as in acute infective spondylitis, tuberculosis involves two or more neighbouring vertebrae and intervertebral discs. Extended tracer uptake can be seen deep in the vertebral bodies, confirming that the chronic granulo- matous process spreads from the end-plate into the vertebral body. Each of these diseases manifests characteristic signs on pinhole images that are comparable to radiographic signs. Granulocytes avidly accumulate in acute infective foci while lymphocytes accumulate primarily in chronic foci. Gallium-67 scans are non-specific, accumulating in both inflammatory and neoplastic lesions. In contrast, pinhole scintigraphy precisely localizes tracer uptake to the synovia, which cover the femoral head and acetabular fossa. Such uptake is due to an increase in blood flow through the anastomotic vascular channels in the inflamed synovium. The tracer uptake may be prominent in the active stage but rapidly returns to normal with rest and conservative treatment. It is to be noted that in the early stage with large synovial effusion, tracer uptake may become reduced due to ischaemia of the femoral head created by capsular distension. However, bone scintigraphy reveals an increased blood flow and blood pool in septic joints, and intense tracer uptake in the subchondral bone on static images in the early stages. The intensity of subchondral tracer uptake in acute pyogenic arthritis has been described as roughly paral- lelling the intensity of infection. Dual head pinhole scintigraphy produces a pair of either the anterior and posterior, or the medial and lateral, images, permitting a three dimensional analysis of the disease. Histologically, it is characterized by the derangement and eventual destruction of the cartilage and subchondral bone without obvious inflammation. Bone scintigraphs may show discrete unifocal or multifocal tracer uptake in subchondral bones, and can be spotty, patchy or segmental in type. Whole body bone scans are the only way to portray symmetric polyarthritis panoramically; spot views can depict characteristic changes in both large and small joints in great detail. Pinhole scintigraphy is useful in delineating many scintigraphic signs of rheumatoid arthritis. Nuclear angiography provides information on lesional vascularity and on the activity of the pathological process. Ankylosing spondylitis is a non- specific inflammatory disease of the sacroiliac joints and the spine. The disease primarily involves the synovial components of the sacroiliac joints and the cartilaginous discovertebral junctions as well as the apophyseal, costovertebral and neurocentral joints of the vertebrae. Planar bone scintigraphy reveals symmetric intense tracer uptake in the sacroiliac joints and/or spine. Pinhole scintigraphy can portray the characteristic ribbon-like tracer uptake in the synovial joints of the spine, producing a ‘bamboo spine’ appearance. In the late stage, tracer uptake becomes reduced, reflecting a quiescent metabolic state. The disease mechanism is still obscure, but an interaction between several different infective organisms and a specific genetic background is currently being given serious consideration. Pathologically, the main alterations are present in the enthesis, which is the site of insertion of a tendon, ligament or articular capsule into the bone, creating characteristic inflammatory enthesopathy. Conspicuous involvement of entheses in this syndrome sharply contrasts with the dominant involvement of the synovium in rheumatoid arthritis. The whole body scan can panoramically reveal characteristic asymmetrical pauciarticular involvement of the spine and appen- dicular bones and joints. Pinhole scintigraphy often detects characteristic enthesopathy in the pre-radiographic stage, especially in the heel and knee. In addition, pinhole scintigraphy can show specific signs of Reiter’s syndrome, namely the ‘knuckle bone’ sign of the sausage digit, the ‘teardrop’ sign of paravertebral enthesopathy and the ‘whisker’ sign of periarticular hyperostosis. It is a rheumatic disorder of clinical importance and academic interest, often related to previous trauma. The pathogenesis has not yet been clarified, although the theory of the internuncial pool is widely accepted. The identification of the ‘sympathetic vasoactive intestinal peptide-containing nerve fibres’ at the cortical bone and the bone–periosteal junction has provided a biochemical basis for the theory. Three phase scintigraphy is useful, revealing increased blood flow and blood pooling, which denotes hyperperfusion. Involvement of periarticular structures of one or more joints of a limb is characteristic. The common causes include trauma, embolism, thrombosis, elevated bone marrow pressure, irradiation and vasculitis. Scintigraphically, avascular necrosis presents as a hot area on the planar image, especially in small bones. However, when magnified using pinhole scintigraphy, a photopenic area can be detected within the hot area. Typical examples are avascular osteonecrosis of the femoral head and of the internal femoral condile of the knee. Common clinical features include a predilection for actively growing bone, chronic exposure to trauma and local pain, and tenderness. Osteochondroses affect the capital femoral epiphysis (Legg–Calvé– Perthes disease), the tarsal navicular bone (Koehler’s disease), the metatarsal head (Freiberg’s disease), the medial clavicular end (Friedrich’s disease), the secondary ossification centres of the vertebrae (Scheuermann’s disease) and the tibial tubercle (Osgood–Schlatter’s disease). Large avascular osteonecrosis produces cold areas, whereas microfractures or bone infraction are represented by hot lesions. Scintigraphy can provide information regarding the size, shape, location, texture and osteochondral junction pattern, frequently leading to specific diagnosis. In elderly patients, it is useful for the study of contusion and fracture in osteoporotic ribs and spine. Bone scintigraphy is valuable for the detection and differential diagnosis of shin splints and stress fractures.

Histological examination confrmed the diagnosis of lipoma from low back pain radiating to both legs and not systematized order hyzaar 12.5 mg. Results: The evolution after 6 months of rehabilitation She had diffculty in micturition with leaks evolving for several was marked by improvement of symptoms and pain purchase hyzaar with amex. The evolution is marked by a worsening of the symptoms The electromyographic examination is still disrupted purchase hyzaar 50 mg mastercard. It visualizes and limiting the walking perimeter with diffculties increasingly a motor impairment with conduction block and neurogenic path. We report the case of a patient with a syndrome of posterior cid paraplegia complicating spinal stenosis, especially at L2-L3 interosseous nerve secondary to compression by a paraostéal lipo- level. The patient received a decompression surgery by L2-L3-L4 ma, surgical excision with radial neurolysis followed by rehabilita- laminectomy. Neurologically, the patient presents paraparesis with tive care adapted enabled good functional recovery after 6 months. Cu- taneo abdominal refexes are present and musculoskeletal refexes are abolished in the lower limbs. However, at the urinary level, it has conducted to North Staffordshire Rehabilitation Centre, Physical Rehabilitation 2 bladder drainage by intermittent self-catheterization. Conclusion: Medicine, Stoke-on-Trent, United Kingdom; North Staffordshire The main vertebral deformities in achondroplastic patient are the Rehabilitation Centre, Physcial Rehabilitation Medicine, Stoke-on- magnum foramen narrows and spinal stenosis. If symptomatic, pa- Trent, United Kingdom tient will present with neurological signs of myelopathy or equina Introduction/Background: Transient bone barrow oedema is a rare, cauda syndrome, as a function of the compression seat. The aim of this study is to ences of neurological signs indicate a decompression surgery. Material and 315 Methods: This is a retrospective descriptive study from the data collected through our bespoke database. Blood parameters including 1Boo-Ali hospital -Islamic Azad university of Medical Sciences infammatory markers were normal. Sayilir 1Muğla Sıtkı Koçman University- Faculty of Medicine, Physical disease that have great effect on quality of life. Material and Methods: genital anomaly characterized by variable degree of defciency In this quasi-experimental clinical trial, postmenopausal women en- along the radial (or preaxial) side of the limb. In this report, we pre- tered the study and randomized into case and control group. Case group also performed back ex- 42-year-old man with right radial bone dysgenesia applied to our tensor strengthening exercises at home. Concerning radial bone dysgenesia, he has 6 months after entering the study in both case and control groups any rehabilitation programs or surgical treatments. The medical history was otherwise non- except for role emotional as a subscale of mental health. On physical examination, right elbow was found to be trol group-, only some physical health dimensions including bodily fxed in extended and right hand fxed in fexion position. He had pain, role physical and vitality and mental health status as a mental minimal motor functions of fngers. Conclusion: In conclusion, performing as taking objects, holding or clutching at the right hand. Right elbow back exercises had major impact on improving physical and most and wrist joint showed severe degenerations. He was recommended of the mental aspects of quality of life in patients with osteoporosis for a rehabilitation program including; improving hand functions, and could be considered in routine management in these patients. Material and Methods: Forty-fve women with postmenopausal osteoporosis who were started medical Medicine and Rehabilitation Department, Ankara, Turkey treatment were prospectively included. Medications included alen- Introduction/Background: Avascular necrosis is the death of bone dronate, zoledronic acid, risedronate or ibandronic acid along with tissue due to a lack of blood supply. Also called osteonecrosis, a low or high dose of calcium plus vitamin D supplements. Patient was diagnosed with malign melanoma vitamin-D supplementation tended to have a greater improvement on right sacral region. Conclusion: Cognitive functions of women with these combination therapy patient experienced right hip pain and postmenopausal osteoporosis remained unaltered, whereas bone limitations. Higher doses of calcium vitamin d supplements were likely treated with 30 session hyperbaric oxygen treatment which did not to have better cognitive effects compared to lower doses. Patient addmited to our rehabilitation J Rehabil Med Suppl 55 Poster Abstracts 97 center for his joint pain and limitations with wheel chair dependent hadaye Tajrish Hospital from Apr 2009 to Apr 2010. Results: After 1 month, both the physiotherapy the patients general health condition and disabilities before treating and dry needling groups had decreased resting, night, and activ- with radiotherapy and chemotherapy. Yahyazadeh3 diology, Adana, Turkey 1Shiraz University of Medical sciences, Physical Medicine & Reha- bilitation- Geriatric Research Center, Shiraz, Iran; 2Shiraz Univer- Introduction/Background: The aim of this prospective pre-study sity of Medical Sciences, Physical Medicine & Rehabilitation- Shi- was to evaluate the effects of lidocaine injections to the trigger 3 points in the trapezius muscle on pain and disability in patients raz Burn Research Center, Shiraz, Iran; Farhangian University, with myofascial pain syndrome. Material and Methods: 20 patients Department of Languages, Shiraz, Iran (15 women and 5 men) with myofascial trigger points in the trape- Introduction/Background: Carpal tunnel syndrome is the most com- zius muscle were included in the study, and clinical examinations mon neurological entrapment in upper extremity and peripheral were used for the diagnosis. It was compared the Shear Wave Velocities (Vs) of the physical examination in diagnostic approach. Shear study was to compare some of these tests in diagnosis of mild carpal Wave Vs of the lesions were analyzed. All patients were treated with a 1 ml% Some different electrodiagnostic methods such as: Interpolation, 10 lidocaine injections to the trigger points by the same physiatrist. Results: The mean age method was sensory part of interpolation (sensitivity: 96% and speci- of the study population was found 43. After the lidocain injection sensitive method to detect mild cases of carpal tunnel syndrome. Conclusion: In patients with myofascial trigger points in the trapezius muscle, lidocain injec- 320 tions effectively improved the disability, and pain. Toshikazu1 prevalence of myofascial pain syndrome and lack of consensus in 1Kyoto Prefectural University of Medicine, Orthopaedics, Kyoto, the best treatment choice, we conducted this study to compare the Japan, 2Kyoto Prefectural University of Medicine, Rehabilitation effectiveness of physiotherapy with dry needling. The diagnosis is clinical and imaging is needed radical neck dissection with preservation of the accessory nerve, in- to confrm the diagnosis and to decide on the appropriate treatment cluding twenty-six men and four women with a mean age of 60. Results: At the time of rehabilitation starting after tion was entered in to the study. The correlation between different clinical tests and ultrasonographic fndings were assessed statistically. Results: Ultrasonographic fndings showed good correlation with clinical 323 fndings. We recommend its use in regular practice because it is Kashf3 user friendly and free from the risk of radiation. Ultrasound helps 1University of Social Welfare and Rehabilitation Sciences, Physi- in reaching at a correct diagnosis because many a times the clinical cal Therapy Department, Tehran, Iran, 2University of Social Wel- features may not give the accurate picture even in best hands.

By O. Gnar. Ohio University.

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