Effects on strength of vibratory exercise compared to walking in postmenopausal women

A major problem associated with advanced adult age is the remarkable decline in functional capacity and the associated loss of independence (1). Muscle strength of the lower extremities is a major neuromuscular determinant of these losses and mobility (2). Vibration exercise is a new method of training with ameliorations on bone (3), balance (4), strength of lower extremities (5, 6) and neuromuscular performance (7), and it easily to apply on previously physically untrained and frail persons. We hypothesized that a low-frequency vibrating board for 8 months would be feasible and improve more the functional capacity and the muscle strength of lower limbs than a walking-based program in post-menopausal women.The present study shows that our WBV training program may have a muscular positive effect, improving explosive strength. Moreover, to our knowledge, the current study is the first had obtained these results using low-frequency vibration in postmenopausal women. WBV seems to require longer sessions to pursue relevant effects on isokinetic strength. Walking programs should be prescribed to achieve significant improvements in health status related with usual daily physical tasks

Diabetic Muscle Infarction

A 58-year-old male with past medical history of diabetes mellitus presented with pain to the bilateral groin for six weeks. Magnetic resonance imaging of the patient’s lower extremities revealed acute myoedema, and he was diagnosed with myositis secondary to diabetic muscle infarction

Disseminated cutaneous gout: a rare manifestation of a common disease

Disseminated cutaneous gout is a rare atypical cutaneous manifestation of gout in which widespread dermal and subcutaneous tophi develop at extra-articular body sites. Given the lack of joint involvement that is typically a feature in tophaceous gout, the diagnosis may not be initially suspected. We present the case of a 50-year-old Hispanic man with poorly controlled gout who was evaluated for several years of firm papulonodules over the trunk and upper and lower extremities, sparing the joints; histopathology confirmed, the diagnosis of disseminated cutaneous gout. Per our literature review, disseminated cutaneous gout presents with polymorphous papules and nodules that can mimic other, more common cutaneous diseases. There is a preponderance of cases in males, Asians, and patients with longstanding gout. The lower extremities are involved in nearly all reports. Uric acid-lowering therapy with allopurinol has been reported to decrease the size and number of lesions in a minority of treated patients

Intramedullary Nailing of Periarticular Fractures

Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed

Cutaneos larva migrans in travelers

The symptoms, medical history, and treatment of 98 patients with cutaneous larva migrans (creeping eruption) who attended a travel-related-disease clinic during a period of 4 years are reviewed. This condition is caused by skin-penetrating larvae of nematodes, mainly of the hookworm Ancylostoma braziliense and other nematodes of the family Ancylostomidae. Despite the ubiquitous distribution of these nematodes, in the investigated group only travelers to tropical and subtropical countries were affected; 28.9% of the patients had symptoms for > 1 month, and for 24.5% the probable incubation period was > 2 weeks. The efflorescences typically were on the lower extremities (73.4% of all locations). The buttocks and anogenital region were affected in 12.6% of all locations, and the trunk and upper extremities each were affected in 7.1%. Only a minority of patients presented with eosinophilia or an elevated serum level of IgE. No other laboratory data appeared to be related to the disease. Therapy with topical thiabendazole was successful for 98% of the patients. Systemic antihelmintic therapy was necessary in two cases because of disseminated, extensive infection

Frictional alopecia of the distal legs: case series and review

BackgroundAcquired alopecia of the lower legs may occur secondary to friction due to socks, footwear, or both on the lower extremities. There is scant literature that reports on this phenomenon.Methods and MaterialsWe describe 5 patients who presented with alopecia of their lower legs induced by socks, footwear, or both.Methods and Materials: We reviewed PubMed for the following terms: ankle alopecia, friction alopecia, frictional alopecia, lower extremity alopecia, non-scarring leg alopecia, and sock alopecia. We also reviewed papers containing these terms and their references.ResultsAcquired frictional alopecia of the lower extremities is often an asymptomatic condition found incidentally on physical examination. The condition can persist for many years despite removal of the source of friction.ConclusionThe incidence of acquired frictional alopecia of the lower extremities may be greater than reflected in previously published reports. It is a non-scarring subtype of alopecia that was noted as an incidental finding during the patient’s dermatology appointment

Growth Series and Random Walks on Some Hyperbolic Graphs

Consider the tesselation of the hyperbolic plane by m-gons, l per vertex. In its 1-skeleton, we compute the growth series of vertices, geodesics, tuples of geodesics with common extremities. We also introduce and enumerate "holly trees", a family of reduced loops in these graphs. We then apply Grigorchuk's result relating cogrowth and random walks to obtain lower estimates on the spectral radius of the Markov operator associated with a symmetric random walk on these graphs.Comment: 21 pages. to appear in monash. mat

Quiet a Puzzle: A Case Report of 15 year Old Female with Severe Anemia Due To Scurvy

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency. She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam notable for trisomy 21 features. Bilateral swelling in lower extremities with the right calf more swollen than left. Perifollicular hyperkeratotic papules with surrounding pinpoint hemorrhage in upper extremities with coiled hair. Lower extremity had large areas of ecchymosis associated with significant tenderness. Reminder of the physical exam and review of the systems is unremarkable. Consent for photographs of exam findings were obtained from parents. She underwent extensive work up which showed normocytic anemia hgb 8.7 g/dL. Elevated D dimer. ANA +. Normal Iron studies, Comprehensive metabolic panel, coagulation studies. Autoimmune work was unremarkable. Hemolysis labs were grossly unremarkable. Hematological work up including ADAMTS12, Paroxysmal nocturnal hemoglobinuria , Factor deficiencies, platelet function assay, protein C , S were unremarkable. Duplex ultrasound , CT and CTA of lower extremities were unremarkable. Vitamin C levels were low and barely detectable at \u3c0.1mg/dl. Patient was started on Vitamin C supplementation of 250 mg twice a day and iron supplementation. She was found to have low B12 and vitamin D.. Significant improvement was notable in Three weeks of treatment as the patient was able to walk. In addition to near complete resolution of her ecchymosis and improvement in her anemia