Havepeele4933

The CombT showed greater improvement on MIP, while IMT compared to EMT, was more effective to improve physical activity. © Georg Thieme Verlag KG Stuttgart · New York.The inflammatory myopathies comprise disorders of immune-mediated muscle injury. The histopathology and clinical features help distinguish them. Juvenile dermatomyositis (JDM) is the most common form of myositis in children and adolescents. Children with JDM present with proximal muscle weakness and characteristic rashes. The presentation is similar in children and adults, but JDM is a primary disorder and the adult form often is concerning for a paraneoplastic syndrome. Proximal muscle weakness occurs with dermatomyositis, polymyositis, and immune-mediated necrotizing myopathy, but the latter two conditions have no dermatologic findings or distinct tissue changes which set them apart from dermatomyositis. Inclusion body myositis, also included in the inflammatory myopathies, presents with more distal involvement, and microscopically exhibits identifiable rimmed vacuoles. We review key features of these disorders, focusing in more detail on JDM because it is more often encountered by the child neurologist. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Children can have a variety of intracranial vascular anomalies ranging from small and incidental with no clinical consequences to complex lesions that can cause substantial neurologic deficits, heart failure, or profoundly affect development. In contrast to high-flow lesions with direct arterial-to-venous shunts, low-flow lesions such as cavernous malformations are associated with a lower likelihood of substantial hemorrhage, and a more benign course. Management of vascular anomalies in children has to incorporate an understanding of how treatment strategies may affect the normal development of the central nervous system. In this review, we discuss the etiologies, epidemiology, natural history, and genetic risk factors of three high-flow vascular malformations seen in children brain arteriovenous malformations, intracranial dural arteriovenous fistulas, and vein of Galen malformations. find more Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  Successful lower extremity reconstruction using free flaps begins by identifying a good recipient vessel and understanding the surrounding environment of the defect. METHODS  One should consider multiple factors when selecting the recipient vessel such as the status of the axial arteries, trying to preserve flow as much as possible, extent and severity of the defect, and ultimately what type of anastomosis will be ideal. RESULTS  Multiple factors of importance are reviewed and show the relevance in decision making and provide an algorithm. CONCLUSION  In addition to the multiple factors to be considered, the ultimate decision should be made on the table during surgery when the actual artery or vein is exposed and shows signs of good pulsation and flow. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging. PATIENTS AND METHODS  This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis. RESULTS  Overall flap survival was 73% and resulted in limb salvage and functional ambulation. Total flap loss was 27% and the majority ended up with high-level amputation. Among the risk factors evaluated, the arterial status of the heel and ASA status significantly increased the odds for failure. When both arterial branches to the heel were impaired, the odds of failure were 80 times higher to fail (p less then 0.05). CONCLUSION  The vascularity of the surrounding tissue of the defect plays a critical role in overall success of diabetic heel reconstruction. Aggressive debridement using the angiosome concept is necessary to assure surrounding tissue has a good circulation. Despite the high chance of failure, success will lead to limb salvage and to reasonable functional ambulation whereas failure to salvage the heel will lead to higher level amputation. This warrants microsurgeons to make an effort to perform reconstruction to the heel defect after obtaining maximal vascularity after angioplasty. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  Antispasmodics, such as scopolamine, are widely used in several countries prior to diagnostic and screening esophagogastroduodenoscopy (EGD), with the goal of optimizing the detection of minute lesions, typically early gastric cancer (T1 lesions). The aim of this study was to determine whether scopolamine facilitates detection of gastric cancer in the screening setting. METHODS A propensity score-matched retrospective study was conducted in a tertiary referral medical center in Tokyo, Japan. Consecutive individuals (n = 40 776) underwent screening EGD between January 2011 and May 2016. All outcome lesions were diagnosed with histopathological confirmation. Detection of esophageal cancer, gastric adenoma, duodenal adenoma, and upper gastrointestinal neoplasia (UGIN) were investigated as secondary outcomes. RESULTS Scopolamine was used in 31 130 patients (76.3 %) and propensity score matching yielded 6625 pairs. Bivariate analysis revealed no significant association between possible confounders (age, sex, overweight, atrophic gastritis, alcohol history, smoking history, midazolam use, endoscopist biopsy rate grade, and gastric cancer in first-degree relatives) and scopolamine use. Lesions detected were 18 gastric cancers, 11 esophageal cancers, 19 gastric adenomas, 6 duodenal adenomas, and 54 UGINs, with no significant association between scopolamine use and lesion detection. CONCLUSIONS Scopolamine use did not appear to effectively facilitate detection of gastric or esophageal cancer, gastric or duodenal adenoma, and UGIN during screening EGD. Scopolamine should be avoided until its efficacy is confirmed by a randomized controlled trial. © Georg Thieme Verlag KG Stuttgart · New York.