Leg injuries

Clausius was an ardent nationalist and patriot. In the Franco-German war of 1870, he took leave of his university duties to enlist (nearing age 50 ) for duties at the front, earning the Iron Cross in 1871. He commanded an ambulance corps of students recmited from Bonn that removed wounded soldiers from front-line action. In one of these engagements, he suffered a leg injury that left him disabled and in pain for life. His passionate advocacy of Germanic culture later led to unfortunate disputes with Thomson, Tait, Maxwell, and others over personal or nationalistic priority for the mechanical theory of heat, the first law, and other discoveries. 

The secondary impact is not assessed, but is assumed to improve with decreasing impact speeds [73, 74]. The actual performance of an active safety system together with the driver (if a driver-relevant component is included) is estimated by weighting the different VERPS+k indices for different speeds according to the performance of the active safety system (including avoided accidents and the probability of avoided head impact on the vehicle). Averaging over all drivers in the population in question and all relevant accident situations, the resulting VERPS+ index is able to quantify the effect of an active safety system [73, 74] once the primary effect of the active safety system (i.e., the reduction of vehicle speed) has been assessed properly. An example for the use of the VERPS index as well as an addition for leg injuries can be found in [75]. 

Venous stasis is slowed blood flow in the deep veins of the legs resulting from damage to venous valves, vessel obstruction, prolonged periods of immobility, or increased blood viscosity. Conditions associated with venous stasis include major medical illness (e.g., heart failure, myocardial infarction), major surgery, paralysis (e.g., stroke, spinal cord injury), polycythemia vera, obesity, or varicose veins. 

Vascular injury may result from major orthopedic surgery (e.g., knee and hip replacement), trauma (especially fractures of the pelvis, hip, or leg), or indwelling venous catheters. 

Once the information is processed and yon (consciously or unconsciously) have decided what it means, yonr nervous system coordinates a response. This is the task of execution. The loop from sensation to processing to execution can occur at many levels. The simplest level is the reflex arc. As noted earlier, when your family doctor strikes your knee with a rubber hammer, the nerves at your knee sense the impact and transmit that information. This information is intercepted and processed well before it ever reaches your consciousness. A reflex center interprets the sensation as a possible threat and automatically executes a command to straighten your knee. The result is a reflex action that protects your leg from injury by kicking away the perceived threat. This sensation to processing to execution loop is completed without any involvement of yonr brain. 

A 75 year old man was examined on a routine visit 1 month after discharge from hospital for a myocardial infarction. No communication had been received from the hospital on the patients stay and management. The patient seemed well but had a few purpuric 1 cm round lesions on his hands. The doctor assessed these as senile purpura. He then noticed that there were several more on both legs. He felt that these were both more extensive than with senile purpura and in an unusual site. He questioned the patient about injury, which the patient denied. On ringing the hospital it was learned that the patient had had a deep venous thrombosis and was treated with warfarin. They apologised for not informing the doctor earlier ... 

Beebe, like Case and Lea, set up three groups mustard gas casualties, pneumonia cases, and those with leg wounds the latter two series excluded any who might possibly have had contact with H. Sample size was set at 2,500 each, but the restrictions left Beebe with groups of 2,718 H casualties, 1,855 cases of pneumonia, and 2,578 men with leg wounds. All in the H group had evidence of H injury to skin, eyes, and respiratory tract. All were born between 1888 and 1893 and were alive on January 1, 1919. Records in the Veterans Administration files enabled Beebe to follow the men up to January 1956. In a followup study of lung-cancer mortality,... 

Fig. 13.1 Cytoprotective action of adenosine in a quantitative model of mouse hindlimb ischemia and reperfusion (I/R) injury. Adult wild type mice were injected with (a) sterile vehicle (0.1% DMSO in phosphate-buffered saline, pH 7.4) or various adenosine receptor agonists (b, c) or antagonist (d, f). (a) Following ischemia and reperfusion, skeletal muscle showed a significant uptake of Evans Blue dye (EBD) in vehicle-treated mice (first part of (a), representative of 7 mice). The contra-lateral leg not subjected to ischemia-reperfusion showed virtually no EBD uptake. In the second part of (a), the same section was stained with rabbit polyclonal anti-skeletal muscle actin antibodies followed by staining with goat anti-rabbit IgG conjugated with FITC. (b) The nonselective adenosine agonist R-PIA caused a large reduction in the EBD-stained area (see both first and second parts to this figure, representative of six mice)...

Wearing a sword carries certain obligations and I had taken as much as I could reasonably be expected to stand. Despite the throbbing pain in my leg, I laid a hand on my sword hilt. Messer, you hide behind a claim of injury or of nervous prostration brought on by grief ... 

Individuals who face extended bedrest or immobilization in order to recover from surgery may also benefit from creatine supplementation. One study, which looked at knee surgery patients in rehabilitation, found that subjects who received creatine intravenously during their recovery gained leg strength faster than those who did not. Further research published in the Archives of Physical Medicine and Rehabilitation in 2002 found that creatine supplementation improved upper body exercise capacity in patients with cervical spinal cord injuries. 

It is believed that metabolic products of TOCP inhibit acetylcholinesterase. Apparently other factors are involved in TOCP neurotoxicity. A study of tri-o-cresylphosphate poisoning in China has described a number of symptoms.4 Initial pain in the lower leg muscles was followed by paralysis and lower limb nerve injury. Patients with mild poisoning recovered after several months, but more severely poisoned ones suffered permanent effects. Despite the devastating effects of TOCP, the percentage of virtually complete recovery in healthy subjects is relatively high. 

This fivefold clinical activity is possessed, to a greater or lesser extent, by all benzodiazepines in current clinical use. The properties of benzodiazepines make them ideally useful for managing anxiety (e.g. diazepam, chlordiazepoxide, lorazepam) insomnia (e.g. diazepam, temazepam, nitrazepam, loprazolam, flurazepam, lormetazepam) epilepsy (e.g. clobazam, diazepam, lorazepam) sports injuries where muscle relaxation is required (e.g. diazepam) and as premedications prior to surgery (e.g. midazolam, lorazepam). The benzodiazepines have a number of other uses, including management of alcohol withdrawal syndrome (chlordiazepoxide, diazepam) and restless legs (clonazepam). Short... 

The safety and tolerability of once-daily oral metrifonate has been evaluated in patients with probable mild to moderate Alzheimer s disease in a randomized, doubleblind, placebo-controlled, parallel-group study (9). Metrifonate was given to 29 patients as a loading dose (2.5 mg/kg) for 2 weeks, followed by maintenance dose (1 mg/kg) for 4 weeks 10 patients received placebo. The proportion of patients who had at least one adverse event was comparable in the two groups metrifonate 76%, placebo 80%. Selected adverse events, defined as those for which the incidence in the metrifonate and placebo group differed by at least 10%, were diarrhea, nausea, leg cramps, and accidental injury. The adverse events were predominantly mild and transient. Those who took metrifonate had a significantly lower heart rate. Metrifonate had no clinically important effect on laboratory tests, such as liver function tests, and did not affect exercise tolerance or pulmonary function. 

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