WorldWideScience

Sample records for amputation stumps

  1. Stump problems in traumatic amputation.

    Science.gov (United States)

    Hirai, M; Tokuhiro, A; Takechi, H

    1993-12-01

    Stump problems in amputations resulting from employment related injuries were investigated in 397 cases in the Chugoku and Shikoku districts of Japan between 1987 and 1991. Ninety-seven patients (24%) had stump problems which interfered the prosthetic fitting. Stump problems of the upper extremity were seen in about 9% (17 amputees), two thirds of which were skin troubles. Stump problems of the lower extremity were seen in about 37% (80 amputees). Certain complaints were associated with specific methods of amputation; abnormal keratosis in Syme's amputation, equinus deformity in Chopart's amputation, reduced muscle power in above the knee (A/K) amputation and joint dysfunction in below the knee (B/K) amputation. Adequate prosthetic fitting was achieved by the modification of the socket and alignment in almost all amputees with stump problems. In only two cases, Chopart's amputation required subsequent Syme's amputation due to equinus deformity with abnormal keratosis. In almost every case, stump problems are avoidable by means of surgeons' deliberate evaluation of the affected limb and adequate choice of the amputation level.

  2. Dermatological changes of amputation stump

    Directory of Open Access Journals (Sweden)

    Arora P

    1993-01-01

    Full Text Available Dermatological changes of stumps of 174 amputees are presented. The commonest dermatological change recorded at the site of amputation stump was hyperpigmentation in 46 (26.4% followed by callosities in 32 (18.3%, scaling in 29 (16.7%, cutaneous atrophy in 20 (11.5%, lichenification in 19(10.9%, traumatic ulcer and bacterial infections in 18 (10.3% each, hypertrophic scar in 14 (8.1%, hypopigmentation and corns in 13 (7.4% each, verrucous hypertrophy of stump in 12 (6.9%, dermatophytic infection in 5(2.9%, stump oedema and phantom limb in 4 (2.3% each, intertriginous dermatitis in 3( 1.7%, allergic contact dermatitis (resin and frictional eczema in 2(1.1% each. Epidermoid cyst, keloid formation, anaesthesia, gangrene and cutaneous horn were recorded in 1 (0.6% each. Atrophy (epidermal and derma, anaesthesia, alopecia and elephantiasis of the stump have not been documented in the literature earlier.

  3. Scintigraphic Evaluation of the Stump Region After Extremity Amputation and the Effect of Scintigraphy on Treatment

    Science.gov (United States)

    Sadic, Murat; Atilgan, Hasan Ikbal; Baskin, Aylin; Cinar, Alev; Koca, Gokhan; Demirel, Koray; Comak, Aylin; Ozyurt, Sinem; Yildirim, Sule; Korkmaz, Meliha

    2016-01-01

    Background We evaluated the stump region with scintigraphy and compared the correlation of treatment modalities and scintigraphic results. Methods Sixty-eight cases with extremity amputation were included in the study. Amputation applied cases underwent four-phase Tc-99m hydroxymethylene diphosphonate scintigraphy. Groups were performed according to the scanning time after amputation and amputation regions. After scintigraphic evaluation, results were recorded into five groups: osteomyelitis, soft-tissue infection, reactive changes secondary to surgery, chronic osteomyelitis, and normal. Post-surgical treatment modalities of the patients were determined and compared with scintigraphic results. Results In the scintigraphic evaluation of stump regions of the 68 amputated cases, 34 patients had acute osteomyelitis, one had chronic osteomyelitis, 16 had soft-tissue infection, and eight had changes secondary to the surgery. Nine of 68 cases had normal scintigraphic features. In the scintigraphic evaluation, 43 patients took antibiotic treatment and 16 had surgery. There was a strong correlation between scintigraphic results and treatment approach (P < 0.0001, r = 0.803) by means of preferred therapy and effectiveness of the therapy according to the scintigraphic results. Scintigraphy need increases with age after amputation and a negative correlation between patient age and scintigraphic need was found (P < 0.02, r = -0.339). There was no pathology in the follow-up in the cases that were scintigraphically normal. Conclusion Bone scintigraphy is a cost-effective, non-invasive, and efficient method that directs treatment in the evaluation of the stump region after amputation. PMID:26858796

  4. Physical rehabilitation of patients with amputation stump of thigh because of trauma

    Directory of Open Access Journals (Sweden)

    Efremova O.V.

    2009-10-01

    Full Text Available The article is exposition essence of problem of renewal of ability to work of a problem of restoration after amputation at the hip. The analysis of the standard program of the standard in traumatology programs of physical rehabilitation of patients after amputation and presents the results of the developed physical rehabilitation of patients with amputating the thigh stumps due to injury. The authors propose to use the means of physical rehabilitation in accordance with the flow dynamics of the reparative processes after amputation and clinical features of injury. All this contributes to the development of compensatory own human capabilities, resulting in remission. Since these funds most physiological, their correct application does not cause complications.

  5. Reconstruction of Chopart's Amputation Stump Using Artificial Dermis Combined with Free Anterolateral Thigh Flap.

    Science.gov (United States)

    Shimizu, Mari; Matsumine, Hajime; Takeuchi, Masaki

    2015-11-01

    A 63-year-old man dropped a metal chunk onto his left foot during his work and suffered a crush injury of the left forefoot. He underwent Chopart's amputation followed by stump coverage with sole skin at the orthopedic department on the same day. He was referred to our department for reconstruction because of poor vascularization and subsequent necrosis of tissue at the stump. After the necrotic tissue was debrided, exposure of the talus bone was noted. An artificial dermis was then applied to the stump wound, followed by local negative pressure wound therapy. After 3 weeks, the generation of a strong dermis-like tissue was observed at the site of artificial dermis grafting. We then performed flow-through free anterolateral thigh flap grafting to reconstruct the stump wound. This procedure involved suturing of the peroneal muscle group and tibialis anterior muscle, which were cut off during Chopart's amputation, and suturing the soft tissue surrounding the calcaneus firmly to the fascia lata of the anterolateral thigh flap, followed by suturing of the flap to the skin defect of the left foot. There were neither postoperative complications, such as skin ulcer and equinus/varus deformity, nor need for secondary repair of the grafted flap, so the patient was able to smoothly enter a rehabilitation program including gait training. The current reconstruction technique for the tissue defect following Chopart's amputation, consisting of artificial dermis grafting, negative pressure wound therapy, and flow-through free anterolateral thigh flap grafting, enabled safe and smooth gait rehabilitation with a forefoot prosthesis. PMID:26893983

  6. [Pain syndromes following amputation. Analysis of 100 affected patients with chronic stump and phantom pain].

    Science.gov (United States)

    Wörz, R; Wörz, E

    1990-02-10

    One hundred amputees (m = 95, f = 5) with a pain syndrome were analysed. In 80 patients post-amputation pain of the lower, in 20 of the upper, extremities presented. Thirty-two patients suffered bouts of pain, 68 constant pain of various types. The most commonly cited type of pain in the patients with intermittent pain was lancinating, in the case of constant pain a burning sensation. In some patients pain occurred immediately after the loss of the limb, in others not until several years, or even decades, later. Forty per cent of our patients indicated that the incidence and intensity of the pain increased with time. Neurological, orthopedic and internistic causes of stump or phantom pain have been described. In 72% of the patients with constant pain and in 34% of those suffering from bouts of pain, an algogenic psychosyndrome had developed. Complications and late sequelae of amputations are of considerable significance for the development and intensity of stump and phantom pain.

  7. Incidental detection of a pseudoaneurysm at an amputation stump in a Tc-99m HMPAO labeled leukocyte scan

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Myung Hee; Jeong, Hwan Jeong; Lim, Seok Tae [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2007-08-15

    A 20-year-old man underwent a Tc-99m HMPAO labeled leukocyte scan for the evaluation of an infection at the stump of an AK amputation, which was conducted due to an open communicated fracture of the left lower leg. Blood-flow and blood-pool images demonstrated a pseudoaneurysm with a focus of intense activity medial to the stump, and centered within a large photopenic defect by surrounding hematoma. Delayed image obtained at 3 hours post-injection showed persistent intense and slight increased activity. Contrast angiography confirmed the presence of a pseudoaneurysm arising from a branch of the left superficial femoral artery.

  8. Amputation

    Science.gov (United States)

    ... of illnesses and disabilities Your health Everyday living Parenting Your rights Women veterans with disabilities Caregiver support ... partially cut off due to an accident or violence. With surgical amputation, a limb or part of ...

  9. The stump and the prosthesis.

    OpenAIRE

    Day, H. J.

    1980-01-01

    In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels.

  10. The stump and the prosthesis.

    Science.gov (United States)

    Day, H J

    1980-03-01

    In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels.

  11. 下肢创伤性截肢后残端问题的影响因素及其手术治疗%Surgical strategies for stump problems following trauma-related amputation of lower extremity

    Institute of Scientific and Technical Information of China (English)

    刘克敏; 王安庆; 唐涛; 赵利; 崔寿昌

    2010-01-01

    目的 探讨下肢创伤性截肢后残端问题的影响因素及其手术治疗.方法 1992年11月至2008年8月共收治72例(80侧)下肢踝关节以上创伤性截肢后因残端问题而进行手术治疗的患者,其中男47例,女25例;年龄9~60岁,平均(28.8±12.4)岁.小腿截肢48侧,大腿截肢32侧.从受伤截肢到因残端问题接受手术治疗的时间平均为32.7个月.对患者残端问题进行评价,将性别、单双侧截肢、截肢部位(大腿与小腿)、致伤原因作为因素,截肢到首次残端修整术时间、软组织多余臃肿、皮肤明显瘢痕、皮肤溃疡、神经瘤、骨刺作为水平,统计分析每一因素与各水平间的关系.通过ADL评分评价手术后的效果.结果 14侧行胫腓骨融合术,12侧残端修整术≥2次,双侧截肢者13例21侧(8例双侧残端同时修整),再截肢5侧.80侧残端问题中有53侧(66.3%)原始截肢时未行残端肌肉固定成形术,瘢痕多者42侧(52.5%),神经瘤38侧(47.5%),软组织过多臃肿皱褶24侧(30.0%),皮肤溃疡14侧(17.5%).原始截肢到首次残端修整术的时间小腿截肢比大腿截肢长,差异存统计学意义(P=0.030);大腿截肢软组织臃肿多于小腿截肢,差异有统计学意义(P=0.007);单侧截肢患者骨刺发生率高于舣侧截肢患者,差异有统计学意义(P=0.018).41例患者入院时ADL评分平均为(85.31±7.24)分,出院时为(95.40±3.92)分,差异有统计学意义(t=-11.536,P=0.000).结论 单双侧截肢、截肢部位是影响下肢创伤性截肢后残端问题的重要因素.选择适当的患者进行残端修整术及胫腓骨融合术可获得良好疗效.%Objective To investigate the surgical management strategies for stump problems fol-lowing trauma-related amputation of lower limb. Methods From November 1992 to August 2008, 72 consecutive patients, who had been troubled by stump problems after above-the-ankle amputation due to trauma, underwent revision surgery of the stump. They were

  12. The Application of Autologous free Bone Plug Technology in Emergency Repair of Amputation Stump Bone Wound%应用自体游离骨塞技术急诊修复截肢残端骨创面

    Institute of Scientific and Technical Information of China (English)

    李贝; 黄瑞良; 区广鹏; 肖军; 刘伟; 杨康胜; 艾合买提江·玉素甫

    2013-01-01

    Objective:Study the efficacy of free bone plug of discarded limbs after amputation in repairing stump bone wound .Meth-ods:From March 2010 to March 2012 , we emergency repaired 6 cases of amputation stump bone wound in autologous free bone plug tech-nology,5 males and 1 female,the age ranged from 21 to 53 years old, average 35 years old.Causes of injuries:5 cases of traffic accident injury, 1 cases of machine strangulation injury .1 case of upper limb amputation , and 4 cases of lower limb amputation .Special examina-tion:1 cases of distal forearm damage;2 cases of thigh supracondylar and intercondylar comminuted fracture , femoral artery nerve de-structive injury and part of the defect;2 cases of the lower leg tibia and fibula comminuted fractures and popliteal artery injury ;1 cases of knee remote defect .After determining the osteotomy plane , retained inner and outer periosteal flap , osteotomy to the bone surface bleed-ing by swing saws ,sanded the edges of the bones . According the debridement amputation bone surface to design the bone plug size , made class cone type bone plug after removing periosteum , the bone plugs bottom of the cortical bone , surrounded by cancellous bone .Its base is trimmed into a slightly curved bone pad according to the cross -section of the stump osteotomy , stuffed stump medullary cavity .used the periosteal flap closure stump marrow cavity after trim the bottom of the bone plug , Soft tissue flaps designed well in advance embedded stump in turn, placed film drainage in the subcutaneous , a large number of cotton pad dressing , plaster cast processing( hard bandage ) . Results:4 patients wounds first class healing and stitches discharged , 2 patients postoperative wound edge effusion whose wound healing after 20-25 days dressing , Followed up for 3-6 months, all stump without sinus formation .1 year after amputation , assembly prosthetic stump skin are good shape , no ulcers and pressure sores .Conclusion:The results were

  13. Amputation surgery.

    Science.gov (United States)

    Schnur, David; Meier, Robert H

    2014-02-01

    The best level of amputation must take into consideration the newest socket designs, methods of prosthetic suspension, and technologically advanced components. In some instances stump revision should be considered, to provide a better prosthetic fitting and function. Targeted reinnervation is a new neural-machine interface that has been developed to help improve the function of electrically powered upper prosthetic limbs. Osseointegrated implants for prosthetic suspension offer amputees an alternative to the traditional socket suspension, and are especially useful for transfemoral and transhumeral levels of amputation. Cadaver bone can be used to lengthen an extremely short residual bony lever arm.

  14. Prosthetic fitting problems of the quasi-Syme amputation.

    Science.gov (United States)

    Rubin, G

    1981-10-01

    Unless the original Syme amputation technique has been precisely followed, an amputation stump capable of tolerating little or no end-bearing will frequently result. Such a stump must be fitted with a below knee type of prosthesis as if the patient were a below-knee amputee. Even though it is not designed for other than a below-knee amputation, the socket can be modified to provide a satisfactory prosthesis for a Quasi-Syme stump.

  15. [Upper leg amputation. Transfemoral amputation].

    Science.gov (United States)

    Baumgartner, R

    2011-10-01

    Objective. Amputation through the diaphysis of the femur at the most peripheral level possible. The stump, covered with soft tissue flaps, is free from pain. It can be fitted with a total contact prosthetic socket. The hip joint is preserved with its full range of motion.Indications. When no possibility to amputate at a more distal level through the tibia or the knee joint exists.Contraindications. When it is possible to amputate at a more distal level.Surgical technique. Symmetrical flaps in the frontal plane are recommended. Asymmetrical flaps and flaps in the sagittal plane can also be made. Their muscles are fixed to each other (myodesis) or the bone end by means of transosseous sutures (myopexy). The ischial nerve has to be shortened about 2 inches proximal to the end of the femur.In peripheral vascular diseases, this procedure is not suitable. An alternative technique is suggested.In chronic osteomyelitis (e.g., after intramedullary nailing), the ventral half of the femur can be removed and the medullary cavity cleansed and filled with a muscular flap in order to maintain length. Lengthening procedures of the femur are discussed.Postoperative management. Avoid active or passive movement of the stump for the first 2 weeks in order not to disturb healing of the muscle sutures. Physical therapy, prosthetic fitting after 4–6 weeks, according to the expected functional level 0–4. Aids: crutches, wheel chair, adjustable bed, modified hand-controlled automobile.The walking ability of a patient with a double amputation above the knee is severely limited and in patients with peripheral artery disease remains the exception.

  16. [Upper leg amputation. Transfemoral amputation].

    Science.gov (United States)

    Baumgartner, R

    2011-10-01

    Objective. Amputation through the diaphysis of the femur at the most peripheral level possible. The stump, covered with soft tissue flaps, is free from pain. It can be fitted with a total contact prosthetic socket. The hip joint is preserved with its full range of motion.Indications. When no possibility to amputate at a more distal level through the tibia or the knee joint exists.Contraindications. When it is possible to amputate at a more distal level.Surgical technique. Symmetrical flaps in the frontal plane are recommended. Asymmetrical flaps and flaps in the sagittal plane can also be made. Their muscles are fixed to each other (myodesis) or the bone end by means of transosseous sutures (myopexy). The ischial nerve has to be shortened about 2 inches proximal to the end of the femur.In peripheral vascular diseases, this procedure is not suitable. An alternative technique is suggested.In chronic osteomyelitis (e.g., after intramedullary nailing), the ventral half of the femur can be removed and the medullary cavity cleansed and filled with a muscular flap in order to maintain length. Lengthening procedures of the femur are discussed.Postoperative management. Avoid active or passive movement of the stump for the first 2 weeks in order not to disturb healing of the muscle sutures. Physical therapy, prosthetic fitting after 4–6 weeks, according to the expected functional level 0–4. Aids: crutches, wheel chair, adjustable bed, modified hand-controlled automobile.The walking ability of a patient with a double amputation above the knee is severely limited and in patients with peripheral artery disease remains the exception. PMID:21975907

  17. Advanced prosthetic techniques for below knee amputations.

    Science.gov (United States)

    Staats, T B

    1985-02-01

    Recent advances in the evaluation of the amputation stump, the materials that are available for prosthetic application, techniques of improving socket fit, and prosthetic finishings promise to dramatically improve amputee function. Precision casting techniques for providing optimal fit of the amputation stump using materials such as alginate are described. The advantages of transparent check sockets for fitting the complicated amputation stump are described. Advances in research that promise to provide more functional prosthetic feet and faster and more reliable socket molding are the use of CAD-CAM (computer aided design-computer aided manufacturing) and the use of gait analysis techniques to aid in the alignment of the prosthesis after socket fitting. Finishing techniques to provide a more natural appearing prosthesis are described. These advances will gradually spread to the entire prosthetic profession.

  18. Tinea corporis on the stump leg with Trichophyton rubrum infection

    Directory of Open Access Journals (Sweden)

    Xin Ran

    2015-09-01

    Full Text Available We report a case of tinea corporis on amputated leg stump caused by Trichophyton rubrum. The patient, a 54-year-old male, experienced a serious traffic accident, resulted his right leg amputated 3 years ago. Since then prosthesis was fitted and protective equipment of silicone stocking was worn for the stump. He consulted with circular, patchy and scaly erythemas with itching on his right below knee amputation stump for 2 months. The diagnoses of tinea corporis on the stump was made based on a positive KOH direct microscopic examination, morphologic characteristics and sequencing of the internal transcribed spacers (ITS 1 and 4, confirmed that the isolate from the scales was T. rubrum. The patient was cured with oral terbinafine and topical naftifine-ketaconazole cream following 2% ketaconazole shampoo wash for 3 weeks. Long times using prosthesis together with protective equipment of silicone stocking, leading to the local environment of airtight and humid within the prosthesis favors T. rubrum infection of the stump could be considered as the precipitating factors.

  19. Productivity and costs of stump rake and stump harvester

    Energy Technology Data Exchange (ETDEWEB)

    Jouhiaho, A.; Rieppo, K.; Mutikainen, A. (TTS Research, Rajamaeki (Finland)), e-mail: aki.jouhiaho@tts.fi, e-mail: kaarlo.rieppo@tts.fi, e-mail: arto.mutikainen@tts.fi

    2010-07-01

    The cost-effectiveness of the two most common stump extraction equipment used in Finland was investigated in the work study: stump rake and stump harvester. The productivity of stump extraction with the stump rake was on average 12,7 m3 / effective hour and with the stump harvester 12,0 m3 /effective hour. Soil preparation performed during the stump extraction decreased the productivity of stump extraction by 1,9-3,1 m3 / effective hour. Considering the work methods adapted by the drivers, the different revolutions of the engines (RPM) used in the excavators and speed of movement, it is not possible to draw a general conclusion that there would be differences in productivity between stump extraction methods at issue. Even though the acquisition price of the stump harvester was almost double that of the acquisition price of the stump rake with bucket tilt mechanism, the operating costs of the stump harvester were lower due to its lower fuel consumption. The hourly operating costs of the stump rake were 4 per cent or EUR 2,0 / hour higher than the operating costs of the stump harvester. Due to the 6 per cent higher productivity of the stump rake, the unit cost of the stump rake was 2 per cent or EUR 0,09 / m3 lower than that of the stump harvester. (orig.)

  20. Amputation and prostheses in Khartoum.

    Science.gov (United States)

    Mohamed, I A; Ahmed, A R; Ahmed, M E

    1997-08-01

    One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor

  1. Amputation of extremity in patients with atherosclerotic gangrene

    Directory of Open Access Journals (Sweden)

    Tsareva Yu.O.

    2011-12-01

    Full Text Available Aim of investigation — to analyze the results of treatment of patients with atherosclerotic gangrene of a limb, to identify the causes of adverse outcomes amputation. Materials and methods: We analyzed the results of examination and treatment of 218 patients with atherosclerotic gangrene of the limb. Good outcome of amputation was considered the primary surgical wound healing of the stump. Suppuration, secondary healing, re-amputation and death we attributed to the adverse results of amputation. Results: The adverse outcomes of amputation due to technical errors in surgery, properly chosen level, inadequate drainage of the wound stump, an unsuccessful operation on the arteries of a limb, inadequate empirical antibiotic therapy, patient's age, functional capabilities of myocardium, the duration of critical ischemia, as well as the lack of psychological adaptation of patients before amputation. Conclusion: To decide the need for amputation in patients with atherosclerotic gangrene follows the assessment of possible vascular reconstructive surgery. In determining the level of amputation is necessary to objectively assess the degree of disruption of regional blood flow using multilevel manometry and laser Dopplerflowmetry. In preparation for amputation should be paid special attention to the correction of rheological and coagulation properties of blood, normalization of the functional state of the myocardium, as well as specialized psychotherapeutic training for timely and adequate psychological adaptation of the patient

  2. Sciatic Neuroma Presenting Forty Years After Above-Knee Amputation

    OpenAIRE

    Kitcat, M; Hunter, J. E.; C.M. Malata

    2009-01-01

    We report a case of a sciatic neuroma presenting forty years after above knee amputation. Patients developing neuroma following a limb amputation can present with stump pain which is commonly resistant to medical intervention. The length of interval from the initial injury to presentation is widely variable. Diagnosis relies on clinical suspicion and accurate assessment, radiological imaging and, if indicated, surgical exploration. MRI provides a better soft tissue definition than CT and is m...

  3. Ectopic banking of amputated great toe for delayed thumb reconstruction: case report.

    Science.gov (United States)

    Valerio, Ian L; Hui-Chou, Helen G; Zelken, Jonathan; Basile, Patrick L; Ipsen, Derek; Higgins, James P

    2014-07-01

    Ectopic banking of amputated parts is a recognized technique for delayed replantation of an amputated part when the amputation stump will not permit immediate replantation. This is conventionally performed with the intent of transferring the injured part back to its anatomic position when the amputation stump is more appropriate for replantation. Current warfare conditions have led to a commonly encountered military trauma injury pattern of multiple extremity amputations with protected trunk and core structures. This pattern poses many challenges, including the limit or absence of donor sites for immediate or delayed flap reconstructive procedures. We describe a case in which we ectopically banked the great toe of an amputated lower extremity for delayed thumb reconstruction.

  4. Does Graft on Flap Method Work on Sequela of Fingertip Amputation?

    Science.gov (United States)

    Sano, Kazufumi; Ozeki, Satoru

    2016-10-01

    The graft on flap method, a useful option for the restoration of fresh fingertip amputation, was applied to the reconstruction of the short fingertip stumps resulting from the initial amputated stump plasties. As a modification, a nail bed graft from the big toe and a small cubic iliac bone graft were substituted for the lost tissues normally reduced as a composite graft in fresh cases. Upon follow-up ranging from 1 to 8 years, the grafted bone was found to have been resorpted in all cases. For the reconstruction of short fingertip stumps after the initial amputated stump plasties, acceptable results have not yet been achieved using the graft on flap method. PMID:27595968

  5. Langtidsbehandling med spinal cord-stimulation hos en patient med kronisk regionalt smertesyndrom type 1 og fantomsmerter efter amputation

    DEFF Research Database (Denmark)

    Enggaard, Thomas P.; Scherer, Christian; Nikolajsen, Lone;

    2008-01-01

    The development of stump and phantom pain after limb amputation in patients with complex regional pain syndrome (CRPS) is very frequent. Stump pain is typically recurred CRPS and the possibilities for effective pharmacological pain relief are often limited. Spinal cord stimulation (SCS) has a wel...

  6. Foot amputation - discharge

    Science.gov (United States)

    Amputation - foot - discharge; Trans-metatarsal amputation - discharge ... You have had a foot amputation. You may have had an accident, or your foot may have had an infection or disease and doctors could ...

  7. The use of bone bridges in transtibial amputations

    Directory of Open Access Journals (Sweden)

    Okamoto Auro Mitsuo

    2000-01-01

    Full Text Available We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.

  8. Stump appendicitis: A rare clinical entity

    Directory of Open Access Journals (Sweden)

    Abhinav Kumar

    2013-01-01

    Full Text Available Stump appendicitis is one of the rare delayed complications after appendectomy with reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. We report an 18-year-old patient with Stump appendicitis, who underwent completion appendectomy laparoscopically.

  9. Amputation and prosthesis implantation shape body and peripersonal space representations

    OpenAIRE

    Elisa Canzoneri; Marilena Marzolla; Amedeo Amoresano; Gennaro Verni; Andrea Serino

    2013-01-01

    Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearin...

  10. [The importance of soft tissue stabilization in trans-femoral amputation].

    Science.gov (United States)

    Gottschalk, F

    2015-06-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved.

  11. Hip arthroplasty in a patient with transfemoral amputation: a new tip.

    Science.gov (United States)

    Boussakri, Hassan; Alassaf, Ihab; Hamoudi, Samir; Elibrahimi, Abdelhalim; Ntarataz, Philbert; ELMrini, Abdelmajid; Dumez, Jean Francois

    2015-01-01

    Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.

  12. Hip Arthroplasty in a Patient with Transfemoral Amputation: A New Tip

    Directory of Open Access Journals (Sweden)

    Hassan Boussakri

    2015-01-01

    Full Text Available Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.

  13. The importance of soft tissue stabilization in trans-femoral amputation : English version.

    Science.gov (United States)

    Gottschalk, F

    2016-03-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved.

  14. [The importance of soft tissue stabilization in trans-femoral amputation].

    Science.gov (United States)

    Gottschalk, F

    2015-06-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved. PMID:25971242

  15. Hip arthroplasty in a patient with transfemoral amputation: a new tip.

    Science.gov (United States)

    Boussakri, Hassan; Alassaf, Ihab; Hamoudi, Samir; Elibrahimi, Abdelhalim; Ntarataz, Philbert; ELMrini, Abdelmajid; Dumez, Jean Francois

    2015-01-01

    Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations. PMID:25737790

  16. The importance of soft tissue stabilization in trans-femoral amputation : English version.

    Science.gov (United States)

    Gottschalk, F

    2016-03-01

    Transfemoral amputations with more proximal amputation levels have the problem of secondary development into flexion and abduction contractures. This is induced by muscle imbalance, especially the loss of adductor muscle insertions when abductor muscle insertions are preserved. This causes considerable problems when fitting prosthetics. Myodesis with insertion of the distally detached adductor magnus muscle to the lateral femoral cortex, introduced here, results in a stronger stump with good muscle balance, and prosthetics fitting is significantly improved. PMID:25875228

  17. Hip Arthroplasty in a Patient with Transfemoral Amputation: A New Tip

    OpenAIRE

    Hassan Boussakri; Ihab Alassaf; Samir Hamoudi; Abdelhalim Elibrahimi; Philbert Ntarataz; Abdelmajid ELMrini; Jean Francois Dumez

    2015-01-01

    Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations.

  18. Difficult to predict early failure after major lower-extremity amputations

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Holm, Gitte; Gebuhr, Peter

    2015-01-01

    INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non......-traumatic lower-extremity amputation. METHODS: We studied a consecutive one-year series of 36 men and 34 women with a median (25-75% quartiles) age of 72 (63-83) years who were treated in an acute orthopaedic ward; 44 below-knee and 26 above-knee amputees of whom 47 had an American Society of Anesthesiologists...... rating above two. Patient characteristics and other factors potentially influencing early amputation failure within 30 days were evaluated. RESULTS: Eleven patients died (16%) and 11 (16%) had a re-amputation at a higher level, whereas four (6%) had a major revision at the same level within 30 days...

  19. Bloqueio isquiático-femoral guiado por ultra-som para revisão de coto de amputação: relato de caso Bloqueo isquiático-femoral guiado por ultrasonido para revisión de muñón de amputación: relato de caso Ultrasound-guided sciatic-femoral block for revision of the amputation stump: case report

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2008-10-01

    peripheral nerves, independently of the ability of obtaining sensitive or motor stimulation. CASE REPORT: This is the case of a patient who underwent revision of the amputation stump at the knee under ultrasound-guided sciatic-femoral block with 40 mL of 0.5% ropivacaine, promoting complete sensitive blockade and excellent surgical anesthesia. CONCLUSIONS: Ultrasound assistance is capable of amplifying the spectrum of uses of peripheral nerve blocks in surgical interventions on amputated limbs in situations neurostimulation cannot be used.

  20. Chopart prosthesis and semirigid foot orthosis in traumatic forefoot amputation. Comparative gait analysis.

    Science.gov (United States)

    Hirsch, G; McBride, M E; Murray, D D; Sanderson, D J; Dukes, I; Menard, M R

    1996-01-01

    Gait was analyzed in seven otherwise healthy males at least 11 mo after they had recovered from a traumatic unilateral transmetatarsal amputation incurred during the course of their usual occupation. All seven were fitted with a semirigid foot orthosis. Four were also fitted with a Chopart prosthesis. Gait was evaluated with forceplate measurements of ground reaction force during free walking, by clinical observation of such ambulation on videotape, and by the subjective impression of the men as obtained by a questionnaire. In all men, with unmodified footwear, with the orthosis, and with the prosthesis, the forceplate data showed an abnormal pattern characterized by reduced stance duration and deficient forward propulsion on the amputated side. The abnormality and asymmetry of ground-reaction forces were less with greater preserved stump length and for a given stump length were with the above-ankle concept (Chopart) prosthesis than with the below-ankle concept. These features were recognized during the clinical analysis of all footwear, but there was an extra irregularity of weight progression noted with the fixed ankle of the Chopart prosthesis. The questionnaire reported stump problems to be the principal difficulty, and the follow-up revealed persistent attempts at surgical management including consideration of amputation at a higher level. It was concluded that the patient and the surgeons are likely to choose preservation of limb length over considerations of function during acute care and that the prosthetic concept best suited to deal with the resulting stump should emphasize unloading the distal part of the stump and smoothing out the impulsive force peak on the stump in late stance to minimize pain and to enhance ambulation capacity.

  1. Prosthetic fitting in a patient with a transtibial amputation due to a congenital vascular malformation of the right leg

    NARCIS (Netherlands)

    Simmelink, Elisabeth K.; Rommers, Gerardus M.; Gardeniers, Jean W. M.; Zijlstra, Henk

    2014-01-01

    Background: The problems of prescribing a prosthesis for a young girl with severe congenital vascular malformation deformity leading to a transtibial amputation. Case description and methods: Due to the high risk of recurrent bleeding and limitations regarding full weight bearing of the stump, a nor

  2. Forces required to vertically uproot tree stumps

    OpenAIRE

    Lindroos, Ola; Henningsson, Marina; Athanassiadis, Dimitris; Nordfjell, Tomas

    2010-01-01

    Stumpwood attracts renewed interest due to increased use of forest biomass for bioenergy. In Nordic countries stumps are generally uprooted with crawler excavators, which have strong cranes (ca. 400 kNm gross lift torque), but are not designed for moving in forest terrain. Their use is based on practical experience with available and tested machine types rather than thorough examinations of requirements, partly due to limited knowledge of force requirements for uprooting of stumps. Therefore,...

  3. Epidemiology of leg amputation

    DEFF Research Database (Denmark)

    Ebskov, L B; Schroeder, T V; Holstein, P E

    1994-01-01

    The number of amputations performed for vascular disease in Denmark has decreased from 1777 (34.5 per 100,000 population) in 1983 to 1288 (25.0 per 100,000) in 1990, a reduction of 28 per cent. This decline coincided with an increase in vascular surgical activity of up to 100 per cent, including ...... studied. These findings suggest that vascular surgery may be responsible for the lower amputation rate.......The number of amputations performed for vascular disease in Denmark has decreased from 1777 (34.5 per 100,000 population) in 1983 to 1288 (25.0 per 100,000) in 1990, a reduction of 28 per cent. This decline coincided with an increase in vascular surgical activity of up to 100 per cent, including...... a marked rise in the rate of femorodistal reconstruction. Moreover, regional variation in vascular surgical activity correlated with percentage reduction in amputation rate (rS = 0.65, P

  4. Wound healing in above-knee amputations in relation to skin perfusion pressure

    DEFF Research Database (Denmark)

    Holstein, P; Dovey, H; Lassen, N A

    1979-01-01

    In 59 above-knee amputations healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 1318-- or 125I--antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mm......Hg no less than nine (82 per cent) suffered severe wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only four cases (8 per cent). The difference in wound complication rate is highly significant (P less than 0.01). The postoperative SPP measured...... on the stumps was on average only slightly and insignificantly higher than the preoperative values, explaining why the preoperative values related so closely to the postoperative clinical course. We conclude that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has...

  5. Clinical evaluation and treatment of stumps in amputees injured in Wenchuan earthquake%地震后截肢患者残肢的临床评定和康复治疗

    Institute of Scientific and Technical Information of China (English)

    武继祥; 刘宏亮; 周贤丽; 刘青山; 汪琴; 尹清; 余洪俊; 吴宗耀

    2008-01-01

    Objective To analyze the feature and cause of stumps of amputees after Wenchuan earthquake,and study the effects of rehabilitation treatment for stumps.Methods Fifty-two cases with stump limbs post-amputation were evaluated,including stump skin status,stump shape,stump length,stump swelling,range of motion (ROM)of joint and strength of stump,and were treated with physical therapy,stump moulding and kinesiotherapy.Results The incidences of stump ulcer,stump swelling,conical stump,short stump and limitation of ROM of joint in all 52 cases were 76%,73%,34%,40%and 42%respectively.After rehabilitation treatment stump ulcers healed,stump swelling eliminated;stump shape,ROM of joint and muscle strength improved obviously.All poor stumps could be fit with the prosthetic limb and get good function.Conclusion The incidences of poor stump limb post·amputation after earthquake were high.Rehabilitation treatment can improve the stump condition.Early comprehensive rehabilitative intervention after amputation is important for fitting the prosthetic limb tO the stump.%目的 分析地震致截肢患者残肢的特点和原因、观察康复治疗的效果.方法 从残端皮肤情况、残肢形态、残肢长度、残肢肿胀、残肢关节活动度和残肢肌力等方面对52条残肢进行评定,并进行物理治疗、残肢塑形和运动治疗.结果 52条残肢中,残端有溃疡或窦道、残肢肿胀、圆锥形残肢和短残肢分别占76%、73%、34%和40%,残肢关节活动受限者占42%,所有患者残肢肌力明显减退.经康复治疗后,残肢无肿胀、溃疡或窦道完全愈合,残肢形状、关节活动度和肌力明显改善,已达到假肢装配条件,均装配假肢,并获得良好的功能.结论 地震后截肢不良残肢发生率高,综合康复治疗能明显改善残肢条件,早期康复治疗对促进患者康复,安装假肢具有重要意义.

  6. Stump sensibility in children with upper limb reduction deficiency

    NARCIS (Netherlands)

    Reinkingh, Marianne; Reinders-Messelink, Heleen A.; Dijkstra, Pieter U.; Maathuis, Karel G. B.; van der Sluis, Corry K.

    2014-01-01

    Objectives: To compare stump sensibility in children with upper limb reduction deficiency with sensibility of the unaffected arm and hand. In addition, to evaluate the associations between stump sensibility, stump length and activity level. Design: Cross-sectional study. Subjects: Children and young

  7. [Coping psychologically with amputation].

    Science.gov (United States)

    Schulz, M

    2009-02-01

    An amputation is a "tragic event" in someone's biography which causes a dramatic change in the outer appearance, the loss of mobility, independence and self esteem. The following article is about how people learn to cope with this difficult situation; with the practical problems of everyday life as well as their emotional problems. It is important for the amputees to go through the different stages of mourning: The first stage is the rejection of the situation. Repression and denial of the loss protects the patient from emotional overstrain. Confrontation is the next step: emotionally as well as mentally. "How could it happen?", (understanding the reasons why ...) "What will my future be like?", "How will I cope?" (ability of coping) "Why did it happen to me?" (sense) The last stage of coping with the amputation is to accept and deal with the new situation and to build up new self-confidence. A successful process of coping leads to a new identity. If a person fails to adapt to the new situation, he will develop an inferiority complex and fall into a depression. He might also try to look for culprit and blame the situation on someone else. About two thirds of all amputees don't cope with their amputation and become depressive. 15% develop symptoms of anxiety. Therefore it is important to offer help. The patients should get together in self helping groups and talk about their experiences and problems. If they need more intensive and individual help, they should have the opportunity to contact a psychologist. During the process of coping with their amputation the patients often alternate between optimistic and pessimistic moods. Sometimes they fall back into a negative and resigned state of mind. This is natural and part of the process as long as they find their own way to a positive attitude and view of life. PMID:19259934

  8. Ectopic major transplantation for salvage of upper and lower extremity amputations

    Directory of Open Access Journals (Sweden)

    Nazerani Shahram

    2013-12-01

    Full Text Available 【Abstract】Objective: Ectopic tissue transplanta- tion is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and re- turning it to its native place at a later date. In this article we present our experience with this demanding procedure. Methods: Debridement was the mainstay of this procedure. The stump and amputated part are carefully de- brided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting. Results: Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The over- all success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the func- tional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job. Conclusion: Ectopic transplantation of body parts is an accepted method of treatment of severely crushed ex- tremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as pu- nishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers. Key words: Replantation; Transplantation; Extremities; Amputation, traumatic

  9. Current achievements with topical negative pressure to improve wound healing in dehiscent ischemic stumps of diabetic patients: a case series.

    Science.gov (United States)

    Georgakarakos, Efstratios; Charalampidis, Dimitris; Kakagia, Despoina; Georgiadis, George S; Lazarides, Miltos K; Papanas, Nikolaos

    2013-06-01

    Negative pressure wound therapy has been increasingly used either as a primary or as an adjunctive therapeutic measure to treat a variety of recalcitrant wounds during the past years. It is thought to act by creating a local environment that promotes cell proliferation, angiogenesis, and granulation tissue formation, leading to accelerated wound healing to the point of spontaneous closure or reducing the wound size to facilitate significantly further surgical reconstruction. This case series presents our preliminary experience with the use of a Topical Negative Pressure system in the treatment of challenging ischemic wounds of diabetic patients. It aims to underscore its beneficial effects and explore its potential role in the management of ischemic amputated stumps to avoid ipsilateral re-amputation at a higher level. PMID:23667104

  10. Does the benefit of salvage amputation always outweigh disability in drug-failure mycetoma?: A tale of two cases

    Directory of Open Access Journals (Sweden)

    Prasanta K Maiti

    2015-01-01

    Full Text Available It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient′s livelihood, psychological aspects and chances of recurrence even after the procedure.

  11. Ectopic major transplantation for salvage of upper and lower extremity amputations

    Institute of Scientific and Technical Information of China (English)

    Shahram Nazerani; Hamed Vaseghi; Saied Hesami; Tina Nazerani

    2013-01-01

    Objective:Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date.In this article we present our experience with this demanding procedure.Methods:Debridement was the mainstay of this procedure.The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap.The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.Results:Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study.The overall success rate was about 70%,lower than expected but these are cases of severe crush injury.Although the functional recovery of these patients are very low,all of the successful cases except one could find a job as a janitor or light manual worker.No patient could return to his previous job.Conclusion:Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries.In our country an amputee has very little chance of finding a job instead a disabled person can.In addition in Iran cultures amputation is seen as punishment of either the God or the society,so it is not well accepted and many patients persist on saving the limb even with no functional recovery.None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.

  12. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    Directory of Open Access Journals (Sweden)

    Shu eImaizumi

    2014-07-01

    Full Text Available Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation. He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic activity on deltoids at the patient’s stump. These results suggest that phantom motor sensation and electromyographic activity on the stump depend on visuomotor synchrony and top-down effects.

  13. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study.

    Science.gov (United States)

    Imaizumi, Shu; Asai, Tomohisa; Kanayama, Noriaki; Kawamura, Mitsuru; Koyama, Shinichi

    2014-01-01

    Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb) has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation). He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic (EMG) activity on deltoids at the patient's stump. These results suggest that phantom motor sensation and EMG activity on the stump depend on visuomotor synchrony and top-down effects.

  14. Wound healing in above-knee amputations in relation to skin perfusion pressure

    International Nuclear Information System (INIS)

    In 59 above-knee amputations healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 132I--or 125I--antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no less than nine (82 per cent) suffered severe wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only four cases (8 per cent). The difference in wound complication rate is highly significant (P<0.01). The postoperative SPP measured on the stumps was on average only slightly and insignificantly higher than the preoperative values, explaining why the preoperative values related so closely to the postoperative clinical course. We conclude that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations. (author)

  15. Pediatric Traumatic Limb Amputation: The Principles of Management and Optimal Residual Limb Lengths.

    Science.gov (United States)

    Khan, Muhammad Adil Abbas; Javed, Ammar Asrar; Rao, Dominic Jordan; Corner, J Antony; Rosenfield, Peter

    2016-01-01

    Pediatric traumatic limb amputations are rare and their acute and long term management can be challenging in this subgroup of patients. The lengthy and costly hospital stays, and resulting physical and psychological implications leads to significant morbidity. We present a summary of treatment principles and the evidence base supporting the management options for this entity. The initial management focuses on resuscitating and stabilization of the patients, administration of appropriate and adequate analgesics, and broad spectrum antibiotics. The patient should ideally be managed by an orthopedic or a plastic surgeon and when an amputation is warranted, the surgical team should aim to conserve as much of the viable physis as possible aimed at allowing bone development in a growing child. A subsequent wound inspection should be performed to assess for signs of ischemia or non-viability of tissue. Depending on the child's age, approximations of the ideal residual limb length can be calculated using our guidelines, allowing an ideal stump length at skeletal maturity for a well-fitting and appropriate prosthesis. Myodesis and myoplasties can be performed according to the nature of the amputation. Removable rigid dressings are safe and cost effective offering better protection of the stump. Complications such as necrosis and exostosis, on subsequent examination, warrant further revisions. Other complications such as neuromas can be prevented by proximal division of the nerves. Successful rehabilitation can be accomplished with a multidisciplinary approach, involving physiotherapist, play therapist and a child psychiatrist, in addition to the surgeon and primary care providers. PMID:27308235

  16. Pulling telescoped phantoms out of the stump: Manipulating the perceived position of phantom limbs using a full-body illusion

    Directory of Open Access Journals (Sweden)

    Laura eSchmalzl

    2011-11-01

    Full Text Available Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as telescoping. Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporarily revoke telescoping sensations in upper limb amputees. During this illusion participants view the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking, which makes them experience the mannequin’s body as their own. In Experiment 1 we used an intact mannequin, and showed that amputees can experience ownership of an intact body as well as referral of touch from both hands of the mannequin. In Experiment 2 and 3 we used an amputated mannequin, and demonstrated that depending on the spatial location of the strokes applied to the mannequin, participants experienced their phantom hand to either remain telescoped, or to actually be located below the stump. The effects were supported by subjective data from questionnaires, as well as verbal reports of the perceived location of the phantom hand in a visual judgment task. These findings are of particular interest, as they show that the temporary revoking of telescoping sensations does not necessarily have to involve the visualization of an intact hand or illusory movement of the phantom (as in the rubber hand illusion or mirror visual feedback therapy, but that it can also be obtained through mere referral of touch from the stump to the spatial location corresponding to that previously occupied by the intact hand. Moreover, our study also provides preliminary evidence for the fact that these manipulations can have an effect on phantom pain

  17. Prosthetic programme after above-knee amputation in children with sarcomata.

    Science.gov (United States)

    Cole, W G; Klein, R W; van Lith, M; Jarvis, R

    1982-01-01

    A programme for early mobilisation using a temporary prosthesis was evaluated in 17 children who had had an amputation above the knee for sarcomata. The temporary prosthesis had a performed adjustable polypropylene quadrilateral socket which was able to accommodate changes in the size of the stump during the first few months after amputation. The adjustable sockets were assembled onto wooden knee-shank-foot units or onto modular components covered with foam. The wooden units were better for routine use as more adjustment was possible between the socket and the knee and because they were more durable in active children. Prosthetic fitting usually took one hour and was carried out 10 days after the amputation to coincide with the start of the chemotherapy programme. The prosthesis was cosmetically acceptable, easy to use and provided a simple and economical way of rehabilitating the amputees and restoring their morale. After two to three months a new prosthesis with a laminated socket suspended by a waistband was supplied. The skin tolerated the closer fit of this socket and the small fluctuations in the size of the stump that occurred with each course of chemotherapy were easily accommodated by varying the thickness of the stump sock. A self-suspending laminated socket was provided after completion of the chemotherapy. The permanent sockets were assembled onto wooden components but the girls usually preferred the modular system covered with foam. The chemotherapy and rehabilitation programmes were successfully co-ordinated so that the children spent as little time as possible away from their normal activities.

  18. Crossover replantation after bilateral traumatic lower limb amputations: a case report

    Directory of Open Access Journals (Sweden)

    Fang Jun

    2012-07-01

    Full Text Available Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replantation. Five years later, the woman had recovered well, and had perfect movement and stability in her replanted leg. After reviewing the literature, we thought that presentation of our patient’s case might provide useful information for clinicians. Conclusions Crossover replantation should be considered when evaluating a patient with bilateral lower limb injuries, thus allowing the patient to touch the ground and stand using their own foot.

  19. Occurrence patterns of lichens on stumps in young managed forests.

    Directory of Open Access Journals (Sweden)

    Måns Svensson

    Full Text Available The increasing demand for forest-derived bio-fuel may decrease the amount of dead wood and hence also the amount of available substrate for saproxylic ( = dead-wood dependent organisms. Cut stumps constitute a large portion of dead wood in managed boreal forests. The lichen flora of such stumps has received little interest. Therefore, we investigated which lichens that occur on stumps in young (4-19 years, managed forests and analyzed how species richness and occurrence of individual species were related to stump and stand characteristics. We performed lichen inventories of 576 Norway spruce stumps in 48 forest stands in two study areas in Central Sweden, recording in total 77 lichen species. Of these, 14 were obligately lignicolous, while the remaining were generalists that also grow on bark, soil or rocks. We tested the effect of characteristics reflecting successional stage, microclimate, substrate patch size, and the species pool in the surrounding area on (1 total lichen species richness, (2 species richness of obligately lignicolous lichens and (3 the occurrence of four obligately lignicolous lichen species. The most important variables were stump age, with more species on old stumps, and study area, with similar total species richness but differences in occupancy for individual species. Responses for total lichen species richness and species richness of obligately lignicolous lichens were overall similar, indicating similar ecological requirements of these two groups. Our results indicate that species richness measurements serve as poor proxies for the responses of individual, obligately lignicolous lichen species.

  20. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    International Nuclear Information System (INIS)

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid–internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  1. Immunocalization of telomerase in cells of lizard tail after amputation suggests cell activation for tail regeneration.

    Science.gov (United States)

    Alibardi, L

    2016-02-01

    Tail amputation (autotomy) in most lizards elicits a remarkable regenerative response leading to a new although simplified tail. No information on the trigger mechanism following wounding is known but cells from the stump initiate to proliferate and form a regenerative blastema. The present study shows that telomerases are mainly activated in the nuclei of various connective and muscle satellite cells of the stump, and in other tissues, probably responding to the wound signals. Western blotting detection also indicates that telomerase positive bands increases in the regenerating blastema in comparison to the normal tail. Light and ultrastructural immunocytochemistry localization of telomerase shows that 4-14 days post-amputation in lizards immunopositive nuclei of sparse cells located among the wounded tissues are accumulating into the forming blastema. These cells mainly include fibroblasts and fat cells of the connective tissue and satellite cells of muscles. Also some immature basophilic and polychromatophilic erytroblasts, lymphoblasts and myelocytes present within the Bone Marrow of the vertebrae show telomerase localization in their nuclei, but their contribution to the formation of the regenerative blastema remains undetermined. The study proposes that one of the initial mechanisms triggering cell proliferation for the formation of the blastema in lizards involve gene activation for the production of telomerase that stimulates the following signaling pathways for cell division and migration.

  2. Transcutaneous oxygen pressure. An effective measure for prosthesis fitting on below-knee amputations.

    Science.gov (United States)

    Casillas, J M; Michel, C; Aurelle, B; Becker, F; Marcer, I; Schultz, S; Didier, J P

    1993-02-01

    After amputation for arterial occlusive disease of the lower limbs, healing and local adaptation to a prosthesis depend on the oxygen ratio in the tissue. Transcutaneous oxygen tension (TcPO2) is a noninvasive microcirculatory exploration. Forty six below-knee stumps were selected without any prosthetic problem excepting vascular, with a follow-up mean duration of 23 months. They were classified into different prosthetic categories. The first was the worst because it required further amputation on the thigh and the fourth the best, which displayed complete adaptation to a socket contact. These groups were related to their TcPO2 values on the anterior and exterior face of the stumps in both reclined and seated positions. It seems that it is impossible to achieve healing when the TcPO2 value is lower than 15 mm Hg in lying position. However, healing is possible above 20 mm Hg but socket contact is not possible when TcPO2 values are under 40 mm Hg. When TcPO2 values are above 40 mm Hg, a good prosthesis fitting is possible when no problems are encountered other than vascular ones.

  3. Pain Management: Post-Amputation Pain

    Science.gov (United States)

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print page Save and share ... by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of the most ...

  4. Distal amputations for the diabetic foot

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2013-07-01

    Full Text Available Minor amputations in diabetic patients with foot complications have been well studied in the literature but controversy still remains as to what constitutes successful or non-successful limb salvage. In addition, there is a lack of consensus on the definition of a minor or distal amputation and a major or proximal amputation for the diabetic population. In this article, the authors review the existing literature to evaluate the efficacy of minor amputations in this selected group of patients in terms of diabetic limb salvage and also propose several definitions regarding diabetic foot amputations.

  5. Phantom pain after eye amputation

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B

    2011-01-01

    Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation......, orbital exenteration or secondary implantation of an orbital implant in the period between 1993 and 2003. A total of 267 patients were identified and invited to participate; of these, 173 agreed to participate. These patients’ medical records were reviewed. A structured interview focusing on pain...... was conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19–88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2–46). Phantom...

  6. A dry powder stump applicator for a feller-buncher.

    Energy Technology Data Exchange (ETDEWEB)

    Karsky, Richard, J.; Cram Michelle; Thistle, Harold

    1998-07-11

    Karsky, D., M. Cram, and H. Thistle. 1998. A dry powder borax stump applicator for a feller-buncher. Presented at the 1998 ASAE Annual International Meeting at Colorado Springs Resort, Orlando, Florida, July 11-16, 1998. Paper No. 987023. ASAE, 2950 Niles Road, St. Joseph, MI 49085-9659. Annosum root rot affects conifers throughout the Northern Hemisphere, infecting the roots and eventually killing the trees. An applicator attachment has been developed that mounts to the back of a feller-buncher saw head, that can reduce mortality from Heterobasidion annosum. The attachment applies a borax powder to a stump immediately after the tree has been cut. This document provides information on the design, development and testing of an applicator for applying dry borax on tree stumps at the time of harvesting to reduce future losses due to root rot.

  7. Complete fifth ray amputation with peroneal tendon transfer--a staged surgical protocol.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2012-01-01

    Nonhealing neuropathic ulcers overlying the fifth metatarsal are frequently associated with cavus foot structure and are often complicated by osteomyelitis. Partial fifth ray amputation for metatarsal phalangeal joint ulceration and osteomyelitis is a time-proven procedure. Recurrent wounds and persistent osteomyelitis at the amputation stump or fifth metatarsal base create significant challenges in a cavus foot with neuropathy. Long-term success with removal of the entire fifth ray is largely dependent on preventing infection of the cuboid and maintaining peroneal tendon function. The described technique demonstrates our surgical principles and technical pearls in performing a staged complete fifth ray amputation with initial antibiotic bead placement and delayed peroneal tendon transfer. The peroneus longus tendon transfer has the advantage of preserving the eversion force to counterbalance the posterior tibial tendon and allowing the first ray to elevate, thereby alleviating some of the sagittal plane deformity associated with a cavus foot structure. The surgical tips and pearls are accompanied by procedure indications and incision planning options. To our knowledge, this is the first report of a staged protocol involving complete fifth ray resection, initial antibiotic bead placement, and delayed peroneus longus tendon transfer. PMID:22621858

  8. Stereotactic body radiation therapy for patients with recurrent pancreatic adenocarcinoma at the abdominal lymph nodes or postoperative stump including pancreatic stump and other stump

    Science.gov (United States)

    Zeng, Xian-Liang; Wang, Huan-Huan; Meng, Mao-Bin; Wu, Zhi-Qiang; Song, Yong-Chun; Zhuang, Hong-Qing; Qian, Dong; Li, Feng-Tong; Zhao, Lu-Jun; Yuan, Zhi-Yong; Wang, Ping

    2016-01-01

    Background and aim The aim of this study is to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) using CyberKnife in the treatment of patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery. Patients and methods Between October 1, 2006 and May 1, 2015, patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery were enrolled and treated with SBRT at our hospital. The primary end point was local control rate after SBRT. Secondary end points were overall survival, time to symptom alleviation, and toxicity, assessed using the Common Terminology Criteria for Adverse Events version 4.0. Results Twenty-four patients with 24 lesions (17 abdominal lymph nodes and seven stumps) were treated with SBRT, of which five patients presented with abdominal lymph nodes and synchronous metastases in the liver and lung. The 6-, 12-, and 24-month actuarial local control rates were 95.2%, 83.8%, and 62.1%, respectively. For the entire cohort, the median overall survival from diagnosis and SBRT was 28.9 and 12.2 months, respectively. Symptom alleviation was observed in eleven of 14 patients (78.6%) within a median of 8 days (range, 1–14 days) after SBRT. Nine patients (37.5%) experienced Common Terminology Criteria for Adverse Events version 4.0 grade 1–2 acute toxicities; one patient experienced grade 3 acute toxicity due to thrombocytopenia. Conclusion SBRT is a safe and effective treatment for patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery. Further studies are needed before SBRT can be recommended routinely. PMID:27418841

  9. Functional results after a Krukenberg amputation

    NARCIS (Netherlands)

    Freire, J; Schiappacasse, C; Heredia, A; Martina, JD; Geertzen, JHB

    2005-01-01

    This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right trans-radial amputation where eventually a Krukenberg procedure was performed, is described a

  10. Forequarter amputation for recurrent breast cancer

    Directory of Open Access Journals (Sweden)

    Krishna N. Pundi

    2015-01-01

    Conclusion: Forequarter amputation can be judiciously used for patients with recurrent or metastatic breast cancer. Patients with recurrent disease without evidence of distant metastases may be considered for curative amputation, while others may receive palliative benefit; disappointingly our patient achieved neither of these outcomes. In the long term, these patients may still have significant psychological problems.

  11. Amputations

    Science.gov (United States)

    ... in the workplace? Yes. The Occupational Safety and Health Administration (OSHA) has the following standards in Title 29 ... gov. U.S. Department of Labor Occupational Safety and Health Administration 2002

  12. Relation of Stump Length with Various Gait Parameters in Trans-tibial Amputee

    Directory of Open Access Journals (Sweden)

    Koyel Majumdar

    2008-07-01

    Full Text Available The purpose of this paper is evaluating the impact of stump length of unilateral below knee amputees (BKA on different gait parameters. Nine unilateral BKA were chosen and divided into three groups comprising patients with short, medium, and long stump length. Each of them underwent gait analysis test by Computer Dynography (CDG system to measure the gait parameters. It was found that the ground reaction force is higher in the patients with medium stump length whereas the velocity, step length both for the prosthetic and sound limb and cadence were high in longer stump length. Statistical analysis shows a significant difference (p<0.05 between the gait parameters of BKA with medium and longer stump length. The patients with longer stump length were more efficient than medium and short stump patients as they consumed comparatively lesser energy while walking with self-selected velocity and conventional (Solid ankle cushioned heel SACH foot.

  13. Wound healing in below-knee amputations in relation to skin perfusion pressure

    DEFF Research Database (Denmark)

    Holstein, P; Sager, P; Lassen, N A

    1979-01-01

    In 60 below-knee amputations the healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I- or 125I--antipyrine mixed with histamine. Of the eight cases with an SPP below 20 mm......Hg, no less than six (75 per cent) failed to heal and required reamputation at the above-knee level. Of the 12 cases with an SPP between 20 and 30 mmHg four cases (33 per cent) failed to heal but of the 40 cases with an SPP above 30 mmHg, there were only four cases (10 per cent) which did not heal...... closely to the postoperative clinical course. We conclude that a low SPP can be used to predict ischaemic wound complications, leading to reamputation at a higher level....

  14. Prostheses, pain and sequelae of amputation, as seen by the amputee.

    Science.gov (United States)

    Chadderton, H C

    1978-04-01

    Results of a survey of 19 organizations belonging to World Veterans Federation indicate that major complains of amputees include; poor fitting, poor dissemination of knowledge to doctors and amputees regarding new prostheses, lack of opportunity for "input" from amputees at research level and inadequate measures to deal with phantom and stump pain. Suggested improvements by amputees; decrease in weight of prostheses, reduction in maintenance for swing and stance-phase control units development of recreational prostheses, more frequent checks through use of X-ray and film techniques, particularly during the "break-in" of a new appliance. Older veterans showed increasing concern in regard to development of consequential disabilities arising from amputation; premature arthritic changes in spine and remaining limb, circulatory problems and gastro-intestinal problems due to ingestion of drugs to control pain.

  15. Wound healing in below-knee amputations in relation to skin perfusion pressure

    International Nuclear Information System (INIS)

    In 60 below-knee amputations the healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I- or 125I--antipyrine mixed with histamine. Of the eight cases with an SPP below 20 mmHg, no less than six (75 per cent) failed to heal and required reamputation at the above-knee level. Of the 12 cases with an SPP between 20 and 30 mmHg four cases (33 per cent) failed to heal but of the 40 cases with an SPP above 30 mmHg, there were only four cases (10 per cent) which did not heal. The difference in failure rate is highly significant (P<0.01). Four out of 30 diabetic patients required reamputation as against 10 out of 30 non-diabetics (0.05< P<0.10) The average SPP was higher in the diabetic group: 57 mmHg (range 18-93 mmHg) compared with 34 mmHg (range 8-68 mmHg) in the non-diabetic group (P<0.001). The postoperative SPP measured on the stumps was on average 8 mmHg higher than the preoperative SPP (P<0.001). The increase took place mainly in stumps with an SPP above 20 mmHg explaining why the preoperative SPP values related so closely to the postoperative clinical course. We conclude that a low SPP can be used to predict ischaemic wound complications, leading to reamputation at a higher level. (author)

  16. Polypoid colonic metastases from gastric stump carcinoma: A case report

    OpenAIRE

    GAO, BINGXIA; XUE, XINYING; Tai, Weiping; Zhang, Jinghui; Chang, Hong; Ma, Xiaorong; Qi, Ying; CUI, LIFANG; YAN, FENGCAI; Pan, Lei

    2014-01-01

    The present study aimed to investigate polypoid colonic metastases from gastric stump carcinoma by performing a retrospective analysis of the clinical data of a patient with such a diagnosis, and by discussing other previous case studies from the literature. The patient of the present study was an 80-year-old male who had undergone a gastrectomy 48 years previously for a benign perforated gastric ulcer. A colonoscopy revealed >10 multiple polypoid lesions of 6–10 mm in diameter distributed th...

  17. 神经断端肌肉内埋入法治疗汶川地震截肢伤员痛性神经瘤%Treatment of painful stump neuroma by resection and nerve stump implantation into muscle in twelve Wenchuan earthquake amputees

    Institute of Scientific and Technical Information of China (English)

    何纯青; 赵正恩; 许猛; 张立海; 柳现飞; 唐佩福

    2011-01-01

    目的:探讨神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤的临床疗效.方法:应用神经断端肌肉内埋入法治疗汶川地震伤截肢伤员痛性神经瘤12例27处,观察术后症状、体征及患肢功能改变情况.结果:12例全部获随访12~26个月,平均16个月.随访时患者主诉肢体残端疼痛和触电感消失;局部无压痛、叩击痛和Tinel征,残端软组织内未触及硬性结节或包块;患肢功能较术前明显改善.结论:采用神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤,可减轻痛苦,疗效确切.%Objective To investigate the clinical efficacy of a painful stump neuroma treatment by resection and nerve stump implantation into muscle in treating Wenchuan earthquake amputees. Methods In 12 Wenchuan earthquake amputees (27 painful neuromas), painful neuroma underwent resection and implantation into the nearby muscle. Changes of symptoms and limb function were observed. Results All the cases were followed up for 12 -26 months with an average of 16 months. It was shown that limb stump pain and “electric -shock” sensation disappeared without any local tenderness, percussion tenderness or Tinel sign. The soft tissue nodule or mass of limb stump disappeared. Limb function improved, compared with preoperative evaluation. Conclusions Pesection and nerve stump implantation into muscle is a feasible and effective method for treatment of painful stump neuroma after amputation.

  18. CT scanning in patients with amputated legs

    International Nuclear Information System (INIS)

    CT scanning after above-knee amputation and below-knee amputation helps to determine the calcium salt content of the examined bones, and to differentiate changes in the surrounding soft parts. By comaring the sides, it is quite easy to detect osteoporotic changes shortly after amputation which would otherwise remain undetected by X-ray film examination. It is equally easy to verify muscular changes, whereas characteristic changes in density allow to determine the share of vacant fat in muscular atrophy. Initial examinations proved the usefulness of CT diagnosis for early detection of dystrophic osseous and muscular changes and also show the possibilities of early therapy control of dystrophy treatment. (orig.)

  19. Ideal functional outcomes for amputation levels.

    Science.gov (United States)

    Meier, Robert H; Melton, Danielle

    2014-02-01

    This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. The following levels are discussed: above knee/transfemoral, below knee/transtibial, above elbow/transhumeral, below elbow/transradial, and bilateral for upper and lower extremities. This classification defines a framework for clinicians to share with patients so that they understand the potential for their expected functional outcomes regarding mobility and activities of daily living, both with and without a prosthesis. Moreover, it addresses some of the vocational and avocational needs of the individual regarding amputation.

  20. Analysis of environmentally friendly harvesting systems for integrated stump fuel and roundwood production

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Simon [Swedish Univ. of Agricultural Sciences, Dept. of Forest Resource Management, Umeaa (Sweden)], e-mail: Simon.Berg@slu.se

    2012-11-01

    Tree stumps could potentially make a significant contribution to the transition from reliance on foreign fossil to renewable domestic energy sources in Sweden, but harvesting them can have unintended negative environmental consequences, largely due to ground disturbance. One way to reduce the ground disturbance is to only harvest the central part of the stump, but this is not profitable using current systems. A possible solution is to integrate stump-centre and roundwood harvests. In the presented study the work, productivity and costs of a conventional, separate stem and stump harvesting system were compared in simulations to an integrated system for simultaneously harvesting stem and stump centre. The conventional system involves use of a harvester, a forwarder, a stump harvester and a stump forwarder, while the integrated system consists of a feller-puller that fells trees with the stump centre attached, a processor and a forwarder. The results indicate that integrated harvests could produce stump wood more cheaply than the current stump harvesting system at sites dominated by trees with breast height diameters exceeding 200 mm, which includes about 80% of the clear-cutting sites in Sweden. The study is not yet complete, the results are thus preliminary and require further validation, but such integrated supply systems are promising and warrant further research.

  1. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

    OpenAIRE

    Karmarkar, Amol M.; Graham, James E.; Reistetter, Timothy A.; Amit Kumar; Jacqueline M. Mix; Paulette Niewczyk; Granger, Carl V.; Ottenbacher, Kenneth J.

    2014-01-01

    The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the ...

  2. Diabetic foot resulting in amputation: our experience

    Directory of Open Access Journals (Sweden)

    K. G. Patel

    2014-02-01

    Conclusions: Foot ulceration in diabetic patients is a resource consuming, disabling morbidity that often is the first step towards lower extremity amputation. Prevention is the best treatment. [Int J Res Med Sci 2014; 2(1.000: 210-214

  3. Inoculum concentration and the colonization of Picea sitchensis stumps by basidiospores of Heterobasidion annosum

    Energy Technology Data Exchange (ETDEWEB)

    Redfern, D.B.; Gregory, S.C.; Macaskill, G.A. [Forestry Commission Research Div., Midlothian (United Kingdom)

    1997-04-01

    The colonization of Sitka spruce stumps by Heterobasidion annosum, and the population structure of colonies, was determined 2-3 years after inoculation with a 10-fold dilution series of basidiospore suspensions. Artificially inoculated stumps were infected more frequently than the controls, which received only natural inoculum. The extent of colonization tended to increase with increasing dilution and reached a maximum at the penultimate dilution, but differences were not significant because of large within-treatment variation. At the higher dilutions stumps fell into poorly-colonized and heavily-colonized groups suggesting that some stumps are inhibitory to infection whereas others are extremely susceptible. Colonized areas resulting from the higher dilution treatments tended to comprise fewer larger genets than those from more highly concentrated spore treatments. The results suggest that the success of establishment by H. annosum in basidiospore colonized stumps represents the outcome principally of intraspecific competition and the constraints on colonization operating within stumps. 30 refs, 2 figs, 2 tabs

  4. Impact of Heterobasidion spp. root rot in conifer trees and assessment of stump treatment

    OpenAIRE

    Wang, Liying

    2012-01-01

    In the thesis four studies were conducted to understand the impact of Heterobasidion spp. on Picea abies, Pinus sylvestris, and Larix × eurolepis in southern Sweden, and the efficacy of stump treatment against infection in order to economically assess control measures. The ability of secondary spread of H. parviporum inoculated on Norway spruce stumps created at precommercial thinning (PCT) was investigated. Stumps with a minimum diameter of 2.5 cm were able to transfer infection to adjace...

  5. Insect assemblages in Norway spruce [Picea abies (L.) Karst.] stumps in the Eastern Sudetes

    OpenAIRE

    Skrzecz, Iwona; Bulka, Maria

    2010-01-01

    The aim of the study was to determine the species composition of insect assemblages colonising stumps of Picea abies (L.) Karst. in mountain conditions. Investigations were carried out in the Eastern Sudetes (south –western Poland) in forest stands situated at 600– 700 m above sea level. The observations were conducted on stumps left behind after felling 70– 90 years old Norway spruces. The analysed stumps were colonised by insects from 21 families of 3 orders: Coleopt...

  6. The arthropod community of boreal Norway spruce forests responds variably to stump harvesting

    OpenAIRE

    Kataja-aho, Saana; Hannonen, Paloma; Liukkonen, Titta; Rosten, Hertta; Koivula, Matti J.; Koponen, Seppo; Haimi, Jari

    2016-01-01

    Forest fuel harvesting increases the need to collect not just logging residues but also tree stumps from harvested stands. This biomass removal has raised concern over forest biodiversity. Here, the effects of stump harvesting on spiders, ants, harvestmen, ground beetles and epiedaphic springtails occupying boreal Norway spruce (Picea abies) forest floor were studied two and five years after harvesting by comparing pitfall trap samples from clear-cut sites with and without subsequent stump ha...

  7. Chemical composition of decomposing stumps in successive rotation of Chinese fir (Cunninghamia lanceolata (Lamb.) Hook.) plantations

    Institute of Scientific and Technical Information of China (English)

    HUANG Zhiqun; XU Zhihong; BOYD Sue; WILLIAMS David

    2005-01-01

    Decomposition of stumps in successive rotation of Chinese fir (Cunninghamia lanceolata (Lamb.) Hook.) plantations was studied using a chronosequence approach. The results showed that decomposition rate constant of Chinese fir stump was 0.02695 as calculated from Olson's model. The N content of stump increased during the first two-year decomposition. When the dead stump C/N ratio was 463.2 ± 27.3, the stumps started to release N. The pattern of P release was similar to that for N. However, K content of stumps showed a consistent declining trend over time during the whole decomposition. 13C nuclear magnetic resonance spectroscopy with cross polarization and magic-angle spinning (13C CPMAS-NMR) was used to analyse organic carbon (C) components in decomposing stumps. The 13C CPMAS-NMR spectra of stumps displayed that stump was dominated by cellulose and hemicellulose. The spectra also showed the accumulation of intensity in alkyl C, aromatic C, and carboxyl C spectral regions, which was expected as the labile cellulose and hemicellulose components in O-alkyl C spectral region were selectively decomposed first.

  8. Stump appendicitis is a rare delayed complication of appendectomy: A case report

    Institute of Scientific and Technical Information of China (English)

    Mehmet Uludag; Adnan Isgor; Muzaffer Basak

    2006-01-01

    Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Paying attention to the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy can prevent the delay of diagnosis and treatment. In patients with stump appendicitis,CT scan not only assists in making an accurate preoperative diagnosis but also excludes other etiologies. We report a 47-year old man with preoperatively diagnosed stump appendicitis by CT, who underwent an open appendectomy 20 years ago.

  9. A Rare Case: Appendectomy After Connected Stump Appendicitis Perforation of the Cecum

    Directory of Open Access Journals (Sweden)

    Berke Manoglu

    2016-01-01

    Full Text Available Stump appendicitis is a rare complication after appendectomy . Stump appendicitis made of incomplete appendectomy after a rest appendix tissue develops as a result of the inflammation. Admitted to the emergency department with acute abdomen and a history of appendectomy in patients with a history of current pain in the right lower quadrant , especially that of the patient must be evaluated in terms of stump appendicitis. The fact that the earlier story appendectomy patients , causing a delay in diagnosis and increasing the morbidity Cecal perforation was offered an advanced case of delayed depending on the stump appendicitis in this article.

  10. The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2014-04-01

    Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.

  11. [Device to assess in-socket pressure distribution for partial foot amputation].

    Science.gov (United States)

    Alvarez-Camacho, Michelín; Urrusti, José Luis; Acero, María Del Carmen; Galván Duque-Gastélum, Carlos; Rodríguez-Reyes, Gerardo; Mendoza-Cruz, Felipe

    2014-07-01

    A device for dynamic acquisition and distribution analysis of in-socket pressure for patients with partial foot amputation is presented in this work. By using the developed system, we measured and generated pressure distribution graphs, obtained maximal pressure, and calculated pressure-time integral (PTI) of three subjects with partial foot amputation and of a group of Healthy subjects (Hs) (n = 10). Average maximal pressure in the healthy group was 19.4 ± 4.11 PSI, while for the three amputated patients, this was 27.8 ± 1.38, 17.6 ± 1.15, 29.10 ± 3.9 PSI, respectively. Maximal pressure-time integral for healthy subjects was 11.56 ± 2.83 PSI*s, and for study subjects was 19.54 ± 1.9, 12.35 ± 1.48, and 13.17 ± 1.31 PSI*s, respectively. The results of the control group agree with those previously reported in the literature. The pressure distribution pattern showed clear differences between study subjects and those of the control group; these graphs allowed us to identify the pressure in regions-of-interest that could be critical, such as surgical scars. The system presented in this work will aid to assess the effectiveness with which prosthetic systems distribute load, given that the formation of ulcers is highly linked to the pressure exercised at the point of contact; in addition, these results will help to investigate the comfort perception of the prosthesis, a factor directly influenced by the stump's pressure distribution.

  12. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    Amol M. Karmarkar

    2014-01-01

    Full Text Available The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501. The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4 and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days and lowest functional rating at discharge (average 79.4. Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25 generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.

  13. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation.

    Science.gov (United States)

    Karmarkar, Amol M; Graham, James E; Reistetter, Timothy A; Kumar, Amit; Mix, Jacqueline M; Niewczyk, Paulette; Granger, Carl V; Ottenbacher, Kenneth J

    2014-01-01

    The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research. PMID:25400948

  14. Short-term responses of decomposers and vegetation to stump removal

    Energy Technology Data Exchange (ETDEWEB)

    Kataja-aho, S.

    2011-07-01

    Stump removal has become a common practice to produce raw material for bioenergy production. It was hypothesized that stump removal is an extensive and more intense disturbance for forest ecosystems (soil decomposer organisms and vegetation) compared to traditional site preparation after clear cutting. Therefore, the effects of stump harvesting on forest soil decomposers, vegetation and nutrient dynamics in undisturbed patches of the forest soil and in exposed mineral soil were compared to the effects of the traditional site preparation method, mounding. Nematodes and enchytraeids were the only decomposer groups that were directly affected (negatively) by the stump removal. Regardless of the treatment, the abundances of most of the decomposer groups were consistently lower in the exposed mineral soil than in the intact forest soil. There was 2-3 times more exposed mineral soil in stump removal sites compared to mounding sites. When this was taken into account, the decomposer community was negatively affected by the stump removal at the forest stand level. However, the greater soil disturbance at the stump harvesting sites enhanced CO{sub 2} production, net nitrogen mineralisation and nitrification. The increased N availability and the changes in microclimate due to the disturbance probably explained the vegetation increase at the stump harvested sites. Planted Norway spruce seedlings grew faster during the first two growing periods at the stump removal sites than at the mounding sites. The seedlings had high and similar ectomycorrhizal colonization rate in both treatments. In the short-term, it is probably not the resources removed in the stumps themselves, but the degree and amount of soil disturbance during the stump harvesting procedure that affects the decomposer community and its function in the clear-felled stands. (orig.)

  15. NUTRITIONAL CONTENT IN Eucalyptus benthamii MINI-STUMP LEAVES

    Directory of Open Access Journals (Sweden)

    Gilvano Ebling Brondani

    2014-08-01

    Full Text Available The aim of this study was to evaluate the foliar nutrient content in Eucalyptus benthamii mini-stumps treated with different Zn and B concentrations during successive shoot collections. Shoots were collected from mini-stumps fertigated with nutrient solutions containing different concentrations of Zn and B (S1 – free of Zn and B; S2 – 0.5 mg L-1 Zn; S3 – 0.5 mg L-1 B; S4 – 0.5 mg L-1 Zn and B; S5 – 1.0 mg L-1 Zn and B; S6 – 2.0 mg L-1 Zn and B. Eight shoot collections from the clonal mini-garden were performed. For each shoot collection, the nutritional content of the leaf was determined (N, P, K, Ca, Mg, S, B, Cu, Fe, Mn and Zn. The experiment was conducted using a randomized design with a factorial arrangement (8x6 and a split plot in time and included three replications. The foliar macro and micronutrient contents varied significantly in relation to the treatments, and the S5 and S6 nutritive solutions presented the best responses.

  16. Bamboo stumps as mosquito larval habitats in Darjeeling Himalayas,India:A spatial scale analysis

    Institute of Scientific and Technical Information of China (English)

    Gautam Aditya; Rakesh Tamang; Dipendra Sharma; Francis Subba; Goutam K.Saha

    2008-01-01

    Bamboo stumps can be a congenial breeding habitat of the mosquitoes.In view of this,a preliminary assessment of the dipteran immatures inhabiting the stumps of bamboo groves in the Darjeeling Himalayas was carried out at a spatial scale.Of the 104 stumps of Dendrocalamus hamiltoni surveyed,70 were found to host immatures of three dipteran species,the mosquitoes Aedes aegypti and Culex quinquefasciatus and the midges Chironomus sp.in varying densities.Though the stumps varied in diameter,in each stump on average 12.1 immatures were found.The abundance of the immatures was positively correlated with the diameter of the stumps (r = +0.382;P < 0.001) but negatively with the pH of the water present in the stumps (r = -0.336;P < 0.01).The coefficient of association was found to be +8.4 for the Ae.aegypti and Chironomus immatures,while in the rest of the species pair the association seemed to be independent.Thus it can be concluded that the stumps in the bamboo groves of Darjeeling Himalayas provides a favourable habitat for the mosquito and chironomid immatures.

  17. Quality of life of eye amputated patients

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Ekholm, Ola; Prause, Jan U;

    2011-01-01

    Purpose: To evaluate eye-amputated patients’ health-related quality of life, perceived stress, self-rated health, job separation because of illness or disability and socioeconomic position. Methods: Patients were recruited from a tertiary referral centre situated in Copenhagen. Inclusion criteria......-administered questionnaire containing health-related quality of life (SF-36), the perceived stress scale and answered questions about self-rated health, job changes because of illness or disability and socioeconomic status. These results were compared with findings from the Danish Health Interview Survey 2005. Results......% of the study population has retired or changed to a part-time job because of eye disease. The percentage of eye amputated patients, who were divorced or separated, was twice as high as in the general population. Conclusion: The impact of an eye amputation is considerable. The quality of life, perceived stress...

  18. Multiple Neuromas Cause Painful "Jumping Stump" in a Transfemoral Amputee: A Case Report.

    Science.gov (United States)

    Buntragulpoontawee, Montana; Pattamapaspong, Nuttaya; Tongprasert, Siam

    2016-09-01

    Painful "jumping stump" is an uncommon but very disturbing complication postamputation. This condition is one of the movement disorder entities resulting from peripheral nerve pathology, often known as "peripherally induced movement disorders." Previously case reports have been written about painful and nonpainful incidence of "jumping stump"; however, only the earliest "jumping stump" article in 1852 suspected that neuromas might influence the involuntary movement. In this study, we describe a 38-year-old man with bilateral transfemoral amputee who suffered from painful "jumping stump" with multiple neuromas confirmed by imaging. He was treated successfully by ultrasound-guided phenol injection into the sciatic neuroma stalks. The pathophysiology of jumping stump and its possible association with neuroma are briefly discussed. PMID:27440797

  19. Successful microsurgical replantation of an amputated penis

    Directory of Open Access Journals (Sweden)

    Sanchit Garg

    2016-01-01

    Full Text Available Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.

  20. Successful Replantation of Amputated Penile Shaft following Industrial Injury

    Directory of Open Access Journals (Sweden)

    A Ariafar

    2010-09-01

    Full Text Available Penile amputation is an uncommon urological emergency. Although rare, traumatic amputation of penis is a challenging injury to treat. However, modern microsurgical reconstruction techniques have improved success rate of penile replantation and become the procedure of choice for managing these patients. Herein, we report on a case of penile amputation following an industrial accident.

  1. CHANGES IN HIP MUSCLES AFTER ABOVE-KNEE AMPUTATION

    NARCIS (Netherlands)

    JAEGERS, SMHJ; ARENDZEN, JH; DEJONGH, HJ

    1995-01-01

    To learn about the changes appearing in hip muscles after an above-knee amputation, 3-dimensional reconstructions of the hip and thigh region of 12 patients with above-knee amputations were made based on transverse magnetic resonance images, In all patients, the amputations were done at least 2 year

  2. Bronchial stump closure with amniotic membrane in animal model

    Directory of Open Access Journals (Sweden)

    Gholamreza Mohajeri

    2014-01-01

    Full Text Available Background: Coverage of the bronchial stumps (BSs with adjacent tissues can improve healing and reduce bronchial complications in complex thoracic surgery. There is no evidence for the application of human amnion allograft for prevention of air leak from the BS. The comparison of the amniotic membrane (AM and pleural patch for BS healing after lobectomy in dogs was our aim in this study. Materials and Methods: A total of eight males and females 12-24-month-old dogs between 17 and 22 kg body-weight were used in this study in 2010, Isfahan University of Medical Sciences. Animals were separated into two groups: group A (n = 4; amniotic membrane and group P (n = 4; pleural patch according to the BS closure technique performed. After lobectomy of the right middle lobe, the BS was closed, while a small bronchopleural fistula (BPF was created by inserting a catheter via edges of closed stump. Then, it was covered with a piece of AM3 × 3 cm in group A and with a pedicle graft of pleura in group P. Rethoracotomy was performed after 15 days of observation, and the BS was removed for histological examination. Histological healing was classified as complete or incomplete healing. Neoangiogenesis was measured by Von Willebrand expression using immunohistochemistry (IHC. Data were analyzed by SPSS version 15 using Fisher′s exact test, Mann-Whitney test, and T tests. Results: BPF complications were not seen during observation period. There was no significant difference in histological healing between two groups. Similarly, no significant difference was observed between the groups in terms of neoangiogenesis based on IHC examination (P value = 0.69. Conclusion: Human amnion allograft could be as effective as pleural patch for BS wrapping following pulmonary resections.

  3. [Problems and techniques of functional rehabilitation of upper limb stump].

    Science.gov (United States)

    Martini, G; Vitangeli, L; Assennato, P; Drommi, M

    1990-07-15

    The authors discuss problems and techniques of rehabilitation in subjects who have undergone upper limb amputation, as well as the requirements for good application of a prosthesis. Various types of prostheses are described: passive ones, those moved by the body and externally operated ones. The amputee undergoes three stages of rehabilitation: a general preparatory phase for maintenance of good joint function and muscle efficiency; a phase of specific rehabilitation with the help of electromyometry and an electronic training device for the use of the prosthesis, and finally individual and group exercises in laboratories with special facilities.

  4. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Science.gov (United States)

    Sommerville, Scott M. M.; Patton, James T.; Luscombe, Jonathan C.; Grimer, Robert J.

    2006-01-01

    We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility. PMID:17496994

  5. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Directory of Open Access Journals (Sweden)

    Scott M. M. Sommerville

    2006-01-01

    Full Text Available We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility.

  6. Body Image, Relationships and Sexuality After Amputation

    Science.gov (United States)

    Body Image, Relationships and Sexuality after Amputation Original article by Sandra Houston, PhD First Step - Volume 4, 2005 Translated into plain language by Helen Osborne of Health Literacy Consulting Text size Larger text Smaller text Java Required Print page Save and share ...

  7. Modeling stump biomass of stands using harvester measurements for adaptive energy wood procurement systems

    Energy Technology Data Exchange (ETDEWEB)

    Vesa, Lauri [ForestCalc Consulting Oy Ltd., 80230 Joensuu (Finland); Palander, Teijo [School of Forest Sciences, University of Eastern Finland, 80100 Joensuu (Finland)

    2010-09-15

    The value and volumes of industrial stump fuel supply are increasing for energy production. Accurate estimates of aboveground and belowground biomass of trees are important when estimating the potential of stumps as a bioenergy source. In this study two stump biomass equations were adapted and tested using them as calibrated stump biomass models computed as the cumulative sum by a local stand. In addition, variables derived from stem measurements of the forest harvester data were examined to predict stump biomass of a stand by applying regression analysis. The true stump yield (dry weight) was used as the reference data in the study. Both biomass models performed well (adjusted R{sup 2} {proportional_to} 0.84) and no advance was found in using other stem dimensions as independent variables in the model. The stand-level model can be used in innovative stump biomass prediction tools for increasing efficiency of energy wood procurement planning to stands within a certain area. In practice, wood procurement managers would need to adapt developed system and decide whether the degree of accuracy/precision provided by the models is acceptable in their local stand harvesting conditions. (author)

  8. Antagonistic effect of fungi from Scots pine stump roots against Heterobasidion annosum and Armillaria ostoyae

    Directory of Open Access Journals (Sweden)

    Hanna Kwaśny

    2014-08-01

    Full Text Available The study presents quantitative and qualitative aspects of fungal colonization of the 2-year-old stump roots of the 30- and 49-year-old Scots pines, and biotic relations between fungi inhabiting the stump roots and major agent s of butt and root rot in Poland, i.e.: H. annosum and A. ostoyae. Compared to the live roots, the increase in density of fungi communities as well as the frequency of the fungi antagonistic towards H. annosum and A. ostoyae, particularly of Trichoderma species. in pine stump roots resulted in the increase of the suppressive effect of these communities towards both pathogens, studied in vitro. This finding may suggest a stronger resistance of pine stump roots to H. annosum and A. ostoyae what under forest conditions may be the example of natural control of both pathogens.

  9. [Suggesting the Significance of Pericardial Fat Pad in Bronchial Stump Fistula].

    Science.gov (United States)

    Fukuoka, Tomoki; Sano, Masaaki; Tominaga, Nasa; Sanada, Shotaro; Uno, Yasuo; Oya, Hisaharu; Nishi, Tetsuo; Koshikawa, Katsumi

    2016-05-01

    Bronchial stump fistula is a post-operative complication with poor outcome after pulmonary lobectomy. In order to prevent this complication, the bronchial stump is covered with pericardial fat tissue in our hospital. The case was 58 year old male who received adjuvant chemotherapy after sigmoidectomy for sigmoid colon cancer. As he developed multiple pulmonary metastases, 48 courses of chemotherapy were performed. The lesions had been localized at the right lower lobe, and neither increase in the size of these lesions nor development of other lesions were observed. Hence, an operation was performed. After right lower lobectomy, the bronchial stump was covered with the pericardial fat tissue. Three months after the operation, he developed pneumothorax, and bubbles were detected inside the fat. The pneumothorax was cured conservatively, and the bubbles disappeared spontaneously after 10 months. It is rare that the patient with bubbles in the covering tissue observed for a long time is cured conservatively, suggesting the significance of the stump pad.

  10. Paul Wittgenstein's right arm and his phantom: the saga of a famous concert pianist and his amputation.

    Science.gov (United States)

    Boller, François; Bogousslavsky, Julien

    2015-01-01

    Reports of postamputation pain and problems linked to phantom limbs have increased in recent years, particularly in relation to war-related amputations. These problems are still poorly understood and are considered rather mysterious, and they are difficult to treat. In addition, they may shed light on brain physiology and neuropsychology. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Several artists have suffered from postamputation complications and this has influenced not only their personal life but also their artistic work. Paul Wittgenstein (1887-1961), a pianist whose right arm was amputated during the First World War, became a famous left-handed concert performer. His case provides insight into Post-World War I musical and political history. More specifically, the impact on the artistic life of this pianist illustrates various postamputation complications, such as phantom limb, stump pain, and especially moving phantom. The phantom movements of his right hand helped him develop the dexterity of his left hand. Wittgenstein played piano works that were written especially for him (the most famous being Ravel's Concerto for the Left Hand) and composed some of his own. Additionally, several famous composers had previously written for the left hand.

  11. Topographic maps of human motor cortex in normal and pathological conditions: mirror movements, amputations and spinal cord injuries.

    Science.gov (United States)

    Cohen, L G; Bandinelli, S; Topka, H R; Fuhr, P; Roth, B J; Hallett, M

    1991-01-01

    We studied motor evoked potentials to transcranial magnetic stimulation in patients with unilateral upper limb amputations, complete T10-T12 spinal cord transection, and congenital mirror movements and in controls. Different muscles in the trunk and upper and lower extremities were evaluated at rest. In controls, muscles could be activated with stimulation of regions several centimeters wide. These areas overlapped extensively when muscles studied were from the same limb and shifted positions abruptly when muscles were from different limbs. Distal muscles were easier to activate than proximal muscles and normally evidenced exclusively a contralateral representation. Congenital defects in motor control in patients with mirror movements resulted in marked derangement of the map of outputs of distal hand muscles with enlarged and ipsilateral representations. Peripheral lesions, either acquired (amputations) or congenital (congenital absence of a limb), resulted in plastic reorganization of motor outputs targeting muscles immediately proximal to the stump. Central nervous system lesions (i.e., spinal cord injury producing paraplegia) also resulted in enlargement of the map of outputs targeting muscles proximal to the lesion. These results indicate that magnetic stimulation is a useful non-invasive tool for exploring plastic changes in human motor pathways following different types of injury.

  12. Application of purse-string suture for management of duodenal stump in radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    SHAO Qin-shu; WANG Yong-xiang; YE Zai-yuan; ZHAO Zhong-kuo; XU Ji

    2011-01-01

    Background Gastric cancer (GC) is the second leading cause of cancer mortality worldwide,and surgical resection is currently the only possible curative approach. Duodenal stump leakage is the most serious complication after radical gastrectomy,and optimal treatment is still lacking.Methods We retrospectively reviewed 2034 cases of total or subtotal gastrectomy for GC from January 1995 to December 2009,including 465 cases of duodenal stump closure using purse-string suture (group A),835 cases of duodenal stump treated with linear cutting stapler and seromuscular layer suture (group B),and 734 cases of duodenal stump closure using full-thickness and seromuscular layer suture (group C). We evaluated the surgical cost,operative time for duodenal stump closure,short-term postoperative complications,perioperative blood loss,and postoperative recovery.Results There was no perioperative mortality in any group. Ninety-four postoperative (within 1 month) complications occurred:18 abdominal bleeding,14 anastomotic leakage,15 abdominal infection,36 wound infection,and 11 duodenal stump leakage. There was no significant difference among the groups in intra-abdominal hemorrhage,anastomotic leakage,abdominal infection and wound infection. No postoperative duodenal stump leakage occurred in group A,which had a significant difference compared with groups B and C (6 cases in group B and 5 cases in group C suffered duodenal stump leakage. P <0.01). The surgical cost in groups A and C was significantly lower than in group B (P <0.01),with no significant difference between groups A and C. The processing time for duodenal stump closure in groups A and B was significantly shorter than in group C (P <0.01),with no significant difference between groups A and B. There was no significant difference in blood loss and postoperative recovery among the groups.Conclusions Duodenal stump closure using purse-string suture seems to be a promising approach with shorter operative time,and lower

  13. Stump treatment against Heterobasidion annosum - Techniques and biological effect in practical forestry

    Energy Technology Data Exchange (ETDEWEB)

    Thor, M. [SkogForsk, Uppsala (Sweden)

    1997-12-31

    This thesis summarises and discusses results from two studies on mechanized stump treatment to control the root rot fungus Heterobasidion annosum (Fr.) Bref. In Sweden, stump treatment is at present carried out with two chemical compounds, urea and disodium octaborate tetrahydrate (DOT), and a biological control agent, Phlebiopsis gigantea (Fr.) Juel. The first study investigated the H. annosum colonization of Norway spruce (Picea abies (L.) Karst) stumps following mechanized thinning and stump treatment with the three control agents mentioned. The stumps were treated in the summer and were compared with untreated stumps, cut in the summer and winter, respectively. Experimental plots were established in 12 first thinning stands of Norway spruce. Six to seven weeks after thinning and treatment, sample discs were collected (N=1246) and examined for presence of H. annosum. Stump treatment with any of the control agents reduced the colonized stump area 6-7 weeks after thinning by 88-98% as compared with untreated stumps cut in the summer. The effects of the different treatments differed neither from each other nor from the effect of winter thinning. The variation between the stands was considerable, but mechanized stump treatment provided as good protection as manual treatment against H. annosum infections. Study II examined the survival of P. gigantea oidiospores in aqueous suspension when exposed to high temperature or pressure, which are potential problems in mechanized application. In the laboratory, temperatures of 20, 30 or 35 deg C did not affect the survival. The spores could withstand 40 deg C for a short period, but died at 60 deg C. Pressure of up to 2 200 kPa for 24 h did not affect P. gigantea spore germination. In the field, temperatures of the working suspension (10{sup 7} spores I{sup -1}) was assessed during practical operations. Spore viability was maintained through the applicator system. As long as the prescriptions are followed up to the time of

  14. [Psychological adjustment following lower limb amputation].

    Science.gov (United States)

    Panyi, Lilla Krisztina; Lábadi, Beatrix

    2015-09-27

    Rehabilitation of lower limb amputees and the fitting of their prosthesis depend highly on the psychological adjustment process and motivational state of the patient. The loss of a limb is extremely challenging and can cause various physical and psychological problems. Depression, anxiety, decreased well-being and quality of life, body image dissatisfaction and changes in self-concept and identity are frequent after lower limb amputation. In the interest of adjustment patients have to cope with the emerging changes and difficulties in their lifes as well as the problems in psychological functioning. It is important for them to accept the alterations in their body and identity, and integrate them in a new self-concept in which process motivation is a fundamental issue. The aim of this article is to review the literature on psychological consequences of lower limb amputation, and to propose an integrative way of rehabilitation for lower limb amputees. PMID:26550913

  15. Obesity paradox in amputation risk among nonelderly diabetic men.

    Science.gov (United States)

    Sohn, Min-Woong; Budiman-Mak, Elly; Oh, Elissa H; Park, Michael S; Stuck, Rodney M; Stone, Neil J; Pearce, William B

    2012-02-01

    The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged amputation risk and amputation-free survival during the next 5 years (2004-2008). Compared to overweight individuals (BMI 25-29.9 kg/m(2)), the risks of amputation and treatment failure (amputation or death) were higher for patients with BMI amputations (HR = 0.53; 95% CI, 0.39-0.73) during follow-up as overweight individuals. While the amputation risk continued to decrease for higher BMI, amputation-free survival showed a slight upturn at BMI >40 kg/m(2). The association between obesity and amputation risk in our data shows a pattern consistent with "obesity paradox" observed in many health conditions. More research is needed to better understand pathophysiological mechanisms that may explain the paradoxical association between obesity and lower-extremity amputation (LEA) risk.

  16. Amputations in Sickle Cell Disease: Case Series and Literature Review.

    Science.gov (United States)

    Maximo, Claudia; Olalla Saad, Sara T; Thome, Eleonora; Queiroz, Ana Maria Mach; Lobo, Clarisse; Ballas, Samir K

    2016-06-01

    In this study, we describe four new patients with sickle cell disease who had limb amputations. Two of the patients had sickle cell anemia [Hb S (HBB: c.20A > T) (β(S)/β(S))] with refractory leg ulcers that required amputations. The third patient had sickle cell trait with an extensive leg ulcer that was associated with epidermoid carcinoma. The fourth patient had amputations of both forearms and feet due to a misdiagnosis of dactylitis. Review of the literature showed that the indications for amputations in sickle cell disease included three distinct categories: mythical beliefs, therapeutic and malpractice. All therapeutic amputations were for severely painful, large, recalcitrant leg ulcers that failed non-interventional therapies. Amputation resulted in pain relief and better quality of life. Phantom neuropathic pain was not a major issue post-operatively. It was absent, transient or well controlled with antidepressants. Limb function was restored post-amputation with prosthetic artificial limbs, wheelchairs or crutches. Malpractice amputations were due to misdiagnosis or to cryotherapy by exposing the painful limb to ice water resulting in thrombosis, gangrene and amputation. We strongly suggest that leg amputations should be considered in the management of certain patients with severe extensive refractory leg ulcers, and topical cryotherapy should never be used to manage sickle cell pain. PMID:27117565

  17. Study on the effect of stump height and number of coppice shoots per stump on some anatomical properties of Eucalyptus camaldulensis Dehn. wood growth in Nineveh plantation

    Energy Technology Data Exchange (ETDEWEB)

    Kasir, W.A.; Barno, J.S.

    1985-01-01

    Fiber length, diameter, wall thickness, the ratio of fiber length to diameter, and vessel element length and diameter were recorded from wood samples collected in an irrigated stand. Stump height significantly affected all anatomical features recorded except fiber wall thickness. The number of coppice shoots had significant effects on all features except vessel diameter. Anatomical variation was greater in the radial direction than along the stem axis. The use of wood from low stumps with 4 shoots is recommended, although wood produced under all conditions studied can be useful for some products. 18 references.

  18. Stump Appendicitis: An Uncompleted Surgery, a Rare but Important Entity with Potential Problems

    Directory of Open Access Journals (Sweden)

    J. A. A. Awe

    2013-01-01

    Full Text Available Appendicectomy for appendicitis is one of the commonest surgical procedures performed worldwide. The residual appendiceal stump left after an initial appendectomy risks the development of stump appendicitis. Stump appendicitis is a real recognized entity but not often considered when evaluating patients with right lower quadrant abdominal pain, especially those with past history of appendectomy. It remains a clinical challenge with the result that its diagnosis and effective treatment are often delayed with possible attendant morbidity or mortality. Stump appendicitis results from obstruction of the lumen of the remaining appendix stump, usually by a faecolith. This increases intraluminal pressure, impairing venous drainage and allowing subsequent bacterial infection. We present the case of a twenty-five (25-year-old female who underwent laparoscopic appendicectomy and presented four and half (4(1/2 months later with fever, right lower quadrant abdominal pain, and tenderness associated with repeated vomiting. Exploratory laparotomy was carried out after clinical and imaging studies which revealed big inflammatory mass with abscess at the right iliac fossa and recurrent appendicitis of the appendiceal stump. Surgical treatment is easy but recognition of this important entity but potentially dangerous condition should always be borne in mind in order to avoid delay in its diagnosis and treatment.

  19. Stumps of Eucalyptus globulus as a source of antioxidant and antimicrobial polyphenols.

    Science.gov (United States)

    Luís, Ângelo; Neiva, Duarte; Pereira, Helena; Gominho, Jorge; Domingues, Fernanda; Duarte, Ana Paula

    2014-10-13

    These past years have seen an enormous development of the area of natural antioxidants and antimicrobials. Eucalyptus globulus is widely cultivated in subtropical and Mediterranean regions in intensive short rotation coppice plantations. In the Portuguese context, E. globulus is the third species in terms of forest area. The stump is the basal part of the tree, including the near-the-ground stem portion and the woody roots that remain after stem felling. The purpose of this work was to study the phytochemical profile and to evaluate the antioxidant and antimicrobial properties of several crude stump wood and stump bark extracts of E. globulus, comparing it with similar extracts of E. globulus wood (industrial chips). The results showed the presence of high concentrations of total phenolic compounds (>200 mg GAE/g extract) and flavonoids (>10 mg QE/g extract) in E. globulus stump extracts. Generally the stump wood extracts stands out from the other ones, presenting the highest percentages of inhibition of linoleic acid oxidation. It was also possible to conclude that the extracts were more active against Gram-positive bacteria, presenting low MIC values. This study thus provides information supporting the economic valorization of E. globulus stump wood.

  20. Morphohistological Features of Pancreatic Stump Are the Main Determinant of Pancreatic Fistula after Pancreatoduodenectomy

    Directory of Open Access Journals (Sweden)

    Cristina Ridolfi

    2014-01-01

    Full Text Available Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management. Aim of the Study. Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy. Patients and Methods. Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue. Results. Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex (P=0.009, BMI≥25 (P=0.002, prolonged surgery (P=0.001, soft pancreatic texture (P<0.001, small pancreatic duct (P<0.001, pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin (P=0.031, large stump area (P=0.001, and extended stump mobilization (P=0.001 were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF (P=0.001. Discussion and Conclusions. Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy.

  1. Morphohistological Features of Pancreatic Stump Are the Main Determinant of Pancreatic Fistula after Pancreatoduodenectomy

    Science.gov (United States)

    Ridolfi, Cristina; Angiolini, Maria Rachele; Gavazzi, Francesca; Spaggiari, Paola; Tinti, Maria Carla; Uccelli, Fara; Madonini, Marco; Montorsi, Marco; Zerbi, Alessandro

    2014-01-01

    Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management. Aim of the Study. Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy. Patients and Methods. Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue. Results. Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex (P = 0.009), BMI ≥ 25 (P = 0.002), prolonged surgery (P = 0.001), soft pancreatic texture (P < 0.001), small pancreatic duct (P < 0.001), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin (P = 0.031), large stump area (P = 0.001), and extended stump mobilization (P = 0.001) were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF (P = 0.001). Discussion and Conclusions. Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy. PMID:24900974

  2. Oxygen supplementation facilitating successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease following trans-tibial amputation: a case report

    Directory of Open Access Journals (Sweden)

    Sharma Sat

    2010-12-01

    Full Text Available Abstract Introduction Dysvascular amputations are increasingly performed in patients with underlying cardiac and pulmonary disorders. A limb prosthesis is rarely offered to patients with severe chronic obstructive pulmonary disease because of their inability to achieve the high energy expenditure required for prosthetic ambulation. We describe a case of successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease with the aid of oxygen supplementation. Case presentation A 67-year-old aboriginal woman with severe chronic obstructive pulmonary disease and hypercapnic respiratory failure underwent right trans-tibial (below the knee amputation for severe foot gangrene. An aggressive rehabilitation program of conditioning exercises and gait training utilizing oxygen therapy was initiated. She was custom-fitted with a right trans-tibial prosthesis. A rehabilitation program improved her strength, endurance and stump contracture, and she was able to walk for short distances with the prosthesis. The motion analysis studies showed a cadence of 73.5 steps per minute, a velocity of 0.29 meters per second and no difference in right and left step time and step length. Conclusion This case report illustrates that patients with significant severe chronic obstructive pulmonary disease can be successfully fitted with limb prostheses and undergo rehabilitation using supplemental oxygen along with optimization of their underlying comorbidities. Despite the paucity of published information in this area, prosthesis fitting and rehabilitation should be considered in patients who have undergone amputation and have severe chronic obstructive disease.

  3. Pirogow’s Amputation: A Modification of the Operation Method

    OpenAIRE

    Bueschges, M.; Muehlberger, T.; Mauss, K. L.; Bruck, J. C.; Ottomann, C.

    2013-01-01

    Introduction. Pirogow's amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (...

  4. Level selection in leg amputation for arterial occlusive disease

    DEFF Research Database (Denmark)

    Holstein, P

    1982-01-01

    measurements of the skin perfusion pressure (SPP). Out of 62 BK amputations with an SPP above 30 mmHg wound healing failed in only 2 cases (3 per cent). Out of 13 BK amputations with an SPP between 20 and 30 mmHg 7 cases (54 per cent) failed and out of 9 BK amputations with an SPP below 20 mmHg no less than 8...... cannot be ruled out by clinical assessment alone and that preoperative determination of the SPP can be used in determining the chance of healing in BK amputations....

  5. Lower-limb amputation and body weight changes in men

    Directory of Open Access Journals (Sweden)

    Alyson J. Littman, PhD

    2015-06-01

    Full Text Available Little is known about the relationship between lower-limb amputation (LLA and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96 and 3,790 men without amputation frequency-matched (5:1 on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline up to 39 mo of follow-up in men with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%–9% increase than in men with a PFA (3%–6% increase. Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.

  6. Predicting prosthetic prescription after major lower-limb amputation

    Directory of Open Access Journals (Sweden)

    Linda Resnik, PT, PhD, OCS

    2015-09-01

    Full Text Available We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001. African American race, longer length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.

  7. Predicting prosthetic prescription after major lower-limb amputation.

    Science.gov (United States)

    Resnik, Linda; Borgia, Matthew

    2015-01-01

    We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.

  8. Predicting prosthetic prescription after major lower-limb amputation.

    Science.gov (United States)

    Resnik, Linda; Borgia, Matthew

    2015-01-01

    We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why. PMID:26562228

  9. Overgrowth of Douglas fir (Pseudotsuga menziesii Franco) stumps with regenerative tissue as an example of cell ordering and tissue reorganization

    OpenAIRE

    Zajączkowska, Urszula

    2014-01-01

    Abstract Main conclusion Stump overgrowth may serve as a unique model for studying cellular reorganization and mechanisms responsible for cell polarity changes during the process of vascular tissue differentiation from initially unorganized parenchymatous cells. Cellular ordering and tissue reorganization during the overgrowth process of the transverse surfaces of Douglas fir stumps in forest stand was studied. At the beginning of stump overgrowth, the produced parenchymatous cells form an un...

  10. Classification of the pattern of intrauterine amputations of the upper limb in constriction ring syndrome.

    Science.gov (United States)

    Al-Qattan, M M

    2000-06-01

    Twenty patients with congenital upper limb amputations caused by constriction rings were reviewed to classify the pattern of these amputations. In the 20 patients studied, 31 upper limbs had congenital amputations. The pattern of amputation was classified into three types. Proximal upper limb amputation was considered type I and was only seen in one limb. The most common pattern of amputation was digital amputation associated with "coning" or "superimposition" of the digits (type II) and was seen in 20 hands. Type II amputations were subclassified according to the involvement of all, ulnar, radial, or central digits by the constriction ring. In type III amputations (N = 10 limbs), there was no associated coning or superimposition of the digits. This type of amputation was subclassified into type IIIA (multiple-digit amputations within the same hand) and type III B (single-digit amputation). Associated anomalies are reviewed and the pathogenesis of constriction rings is discussed.

  11. FROM CULTURAL IMPOTENCE TO CULTURAL AMPUTATION

    Directory of Open Access Journals (Sweden)

    Sukhanov Vyacheslav Vladimirovich

    2013-02-01

    Full Text Available Cultural space of any state is formed by a population that is within its borders. In this article, the author introduces a new cultural definitions «cultural impotence» and «cultural amputation», justifying their use, both in terms of population of the Russian Federation and the European Union and America. The article analyzes the state of society and the cultural factors that influence the development of society in Russia, there are options to bring the country out of a deep cultural crisis. Also established a close relationship between the domestic policy of the state and development of culture.

  12. Mucormycosis: a rare complication of an amputation.

    Science.gov (United States)

    de Chaumont, Arthus; Pierret, Charles; Janvier, Frédéric; Goudard, Yvain; de Kerangal, Xavier; Chapuis, Olivier

    2014-05-01

    Mucormycosis is a rare but serious opportunistic fungal infection. Several clinical forms have been described, including cutaneous localization that is frequently associated with soft tissue trauma or burns. We report a case of cutaneous mucormycosis in a diabetic patient with severe occlusive arterial disease. The diagnosis was made early with mold growth on an amputation wound and the presence of nonseptate hyphae on direct microscopic examination, later identified on culture as Lichtheimia ramosa. Aggressive treatment, including the control of underlying diseases, systemic and local amphotericin B, and extensive surgical debridement permitted successful outcomes.

  13. Effect of Stump Length on Postural Steadiness During Quiet Stance in Unilateral Trans-Tibial Amputee

    Directory of Open Access Journals (Sweden)

    P. Lenka

    2010-01-01

    Full Text Available Although force platform based Center of pressure (COP measures of postural steadiness have been used to test the diagnostic significance of various cerebellar and labyrinthine lesions, but very few literature are available on amputees. The aim of this work is to measure the effect of stump length of Trance-Tibial amputee on postural steadiness during quiet stance. The COP variation, which is the major determinant of stability, has been evaluated. Twenty transtibial amputee patients (age: 34±9.57 years participated in this study. Among them, ten patients were having stump length of (19.33±2.04 cm and ten patients were having stump length of (9.2±0.91 cm. Postural stability is evaluated considering following factors like, AP range, ML range, RMS distance, mean distance, sway velocity, sway area and mean power frequency. The result shows that the mean value of all the measure parameters are having higher values in case of patients having shorter stump length than there counterpart. Therefore, it is concluded that transtibial amputee with longer stump length has better postural steadiness.

  14. Common Carotid Artery Stump Syndrome Due to Mobile Thrombus Detected by Carotid Duplex Ultrasonography.

    Science.gov (United States)

    Omoto, Shusaku; Hasegawa, Yuki; Sakai, Kenichiro; Matsuno, Hiromasa; Arai, Ayumi; Terasawa, Yuka; Mitsumura, Hidetaka; Iguchi, Yasuyuki

    2016-10-01

    Carotid stump syndrome is a cause of recurrent embolic stroke following occlusion of the ipsilateral internal carotid artery. The present report describes a case of recurrent cerebral embolism ipsilateral to a chronically occluded left common carotid artery (CCA), i.e., "CCA stump syndrome." Doppler color flow imaging showed anterograde flow in the left internal and external carotid arteries, which were supplied by collateral flow from the superior thyroid artery inflowing just proximal to the left carotid bifurcation. According to carotid duplex ultrasonography (CDU), a low-echoic mobile thrombus was noted at the distal stump of the occluded CCA, which presumably caused distal embolism. The low-echoic mobile thrombus dramatically changed to a homogenously high-echoic thrombus, and there was no recurrence of stroke after antiplatelet and anticoagulant therapy. This is the first report to demonstrate a CDU-verified temporal change in the thrombus at the stump in CCA stump syndrome. CDU is a noninvasive and useful technique to characterize hemodynamics, thrombus morphology, and the response to therapy. PMID:27567297

  15. Lower-limb amputation and body weight changes in men.

    Science.gov (United States)

    Littman, Alyson J; Thompson, Mary Lou; Arterburn, David E; Bouldin, Erin; Haselkorn, Jodie K; Sangeorzan, Bruce J; Boyko, Edward J

    2015-01-01

    Little is known about the relationship between lower-limb amputation (LLA) and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96) and 3,790 nondisabled persons frequency-matched (5:1) on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline during up to 39 mo of follow-up in participants with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%-9% increase) than in men with a PFA (3%-6% increase). Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.

  16. Lower-limb amputation and body weight changes in men.

    Science.gov (United States)

    Littman, Alyson J; Thompson, Mary Lou; Arterburn, David E; Bouldin, Erin; Haselkorn, Jodie K; Sangeorzan, Bruce J; Boyko, Edward J

    2015-01-01

    Little is known about the relationship between lower-limb amputation (LLA) and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96) and 3,790 nondisabled persons frequency-matched (5:1) on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline during up to 39 mo of follow-up in participants with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%-9% increase) than in men with a PFA (3%-6% increase). Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue. PMID:26244755

  17. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation

    DEFF Research Database (Denmark)

    van Battum, P; Schaper, N; Prompers, L;

    2011-01-01

    The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres....

  18. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear

    Directory of Open Access Journals (Sweden)

    Paulo Moraes Agnollitto

    2016-02-01

    Full Text Available Abstract The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.

  19. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear*

    Science.gov (United States)

    Agnollitto, Paulo Moraes; Chu, Marcio Wen King; Lorenzato, Mario Muller; Zatiti, Salomão Chade Assan; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma. PMID:26929462

  20. Physical and social factors determining quality of life for veterans with lower-limb amputation(s)

    DEFF Research Database (Denmark)

    Christensen, Jan; Ipsen, Thomas; Doherty, Patrick;

    2016-01-01

    of the literature to summarize any evidence on the physical and social determinants for HRQoL in veterans with uni- or bilateral lower-limb amputation(s). Method MEDLINE, EMBASE, PEDro, CINAHL, Scopus and Cochrane databases were searched systematically for eligible studies. Inclusion criteria were: traumatic lower...

  1. Temporary prosthetic fitting for below-knee amputation.

    Science.gov (United States)

    Ozyalcin, H; Sesli, E

    1989-08-01

    The problems encountered in fitting and using the permanent below-knee prosthesis in developing countries are the high price of the prosthesis, inadequate fitting and lack of proper rehabilitation. In Turkey, the preferred treatment of the stump post-operatively is by the soft dressing method with bandaging for maturation and shrinkage. Generally, the application of the permanent prosthesis is in the sixth month post-operatively. Since in patellar-tendon-bearing (PTB) sockets, stumps have to withstand high pressures in limited areas, the PTB socket can only tolerate small volume changes in the stump. For this reason bandaging over a long period may be insufficient for adequate stump shrinkage and amputees will need another below-knee prosthesis, which most of them cannot afford after only a few weeks use. In the authors' clinic, 19 amputees were fitted with simple, effective and inexpensive temporary prostheses following either conventional immediate post-operative dressing or the soft dressing method. The temporary prosthesis is worn for two months. It produces fast stump shrinkage, helps maturation and permits ambulatory discharge even in bilateral amputees. For economical reasons, only eight of nineteen patients were fitted with permanent prostheses, all wearing them successfully without the necessity of further rehabilitation.

  2. Stump entrapment of the anterior cruciate ligament in late childhood and adolescence

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, Arthur B.; Laor, Tal; Zbojniewicz, Andrew M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2011-08-15

    Displacement of a portion of the torn anterior cruciate ligament (ACL) into the intercondylar notch can cause a focal fibrotic reaction similar to that seen following ACL reconstruction. This displacement, which can result in locking or limitation of knee extension, is termed stump entrapment and is described in adult MR imaging literature. We present a pictorial essay of the etiology and appearance of stump entrapment on MR imaging of the knee in an older child and adolescents and review the significance of this finding. (orig.)

  3. Mycobionta of birch and birch stump roots and its possible effect on the infection by Armillaria spp. I.

    Directory of Open Access Journals (Sweden)

    Hanna Kwaśna

    2014-08-01

    Full Text Available Zygorhynchus moelleri was the dominating species on/in roots of 2 year-old stumps of the 49 year-old birches. Trichoderma viride was more frequently found in the fine roots of living birches than in the fine roots of stumps though its population increased in thick roots of stumps. Occasionally the fungus also occurred on the surface of fine roots of stumps. Z. moelleri is known to produce indole 3-ethanol and indole-3 acetic acid which stimulate the growth of A. ostoyae rhizomorphs and phenoloxidizing enzymes which play an important role in the degradation of the wood. It seems that the accumulation of Z. moelleri and absence of bigger populations of T. viride on/in roots of 2-year-old stumps of the 49 year-old birches may result in an increase of their susceptibility to Armillaria infection.

  4. FROM CULTURAL IMPOTENCE TO CULTURAL AMPUTATION

    Directory of Open Access Journals (Sweden)

    Вячеслав Владимирович Суханов

    2013-04-01

    Full Text Available Cultural space of any state is formed by a population that is within its borders. In this article, the author introduces a new cultural definitions «cultural impotence» and «cultural amputation», justifying their use, both in terms of population of the Russian Federation and the European Union and America. The article analyzes the state of society and the cultural factors that influence the development of society in Russia, there are options to bring the country out of a deep cultural crisis. Also established a close relationship between the domestic policy of the state and development of culture.DOI: http://dx.doi.org/10.12731/2218-7405-2013-2-1

  5. Minor amputations for diabetic foot salvage

    Directory of Open Access Journals (Sweden)

    Salah Y. Habel

    2015-10-01

    Full Text Available Foot ulceration in diabetic patients is a frequent complication of diabetes mellitus (DM, necessitating hospitalization for control of infection, wound care and glycemic control. These patients are at risk for potential loss of the involved limb as well as for future loss of the contralateral limb. Diabetic foot is the consequence of peripheral neuropathy complicated by infrapopliteal peripheral vascular disease. Most of the patients present with chronic plantar ulceration and with cellulitis or an abscess. In a significant number of patients, it is observed that the frequency of life or limb threatening infection is less with an intact skin cover. Limb salvage employs the use of culture specific antibiotics, sharp debridement or a minor amputation, wound care and/or skin cover as the situation demands.

  6. A modified scintigrafic technique for amputation level selection in diabetics

    International Nuclear Information System (INIS)

    A modified 123I-antipyrine cutaneous washout technique for the selection of amputation levels is described. The modifications imply a reduction of time needed for the examination by simultaneous recordings on different levels, and a better patient acceptance by reducing inconvenience. Furthermore, both skin perfusion pressure (SPP) and skin blood flow (SBF) are determined from each clearance curve. In a prospective study among 26 diabetic patients presenting with ulcers or gangrene of the foot, both SPP and SBF were determined preoperatively on the selected level of surgery and on adjacent amputation sites. These 26 patients underwent 12 minor foot amputations and 17 major lower limb amputations. Two of these amputations failed to heal. SBF values appeared indicative for the degree of peripheral vascular disease, as low SBF values were found with low SPP values. SPP determinations revealed good predictive values: All surgical procedures healed when SPP>20 mmHg, but 2 out of 3 failed when SPP<2 mmHg. If SPP values would have been decisive, the amputation would have been converted to a lower level in 6 out of 17 cases. This modified scintigrafic technique provides accurate objective information for amputation level selection. (orig.)

  7. Pirogow’s Amputation: A Modification of the Operation Method

    Directory of Open Access Journals (Sweden)

    M. Bueschges

    2013-01-01

    Full Text Available Introduction. Pirogow’s amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score. Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used. Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow’s amputation only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility. Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference.

  8. Prospective comparison of noninvasive techniques for amputation level selection

    International Nuclear Information System (INIS)

    This study prospectively compared the following tests for their accuracy in amputation level selection: transcutaneous oxygen, transcutaneous carbon dioxide, transcutaneous oxygen-to-transcutaneous carbon dioxide, foot-to-chest transcutaneous oxygen, intradermal xenon-133, ankle-brachial index, and absolute popliteal artery Doppler systolic pressure. All metabolic parameters had a high degree of statistical accuracy in predicting amputation healing whereas none of the other tests had statistical reliability. Amputation site healing was not affected by the presence of diabetes mellitus nor were the test results for any of the metabolic parameters

  9. The social and economic consequences of finger amputations.

    Science.gov (United States)

    Hovgaard, C; Angermann, P; Hovgaard, D

    1994-06-01

    120 patients with amputation of at least 1 of the 4 ulnar fingers were admitted to hospital. In none was replantation considered to be possible because of serious damage to the soft tissues and bone. 12 (3-18) years after the accident 80 percent of the patients assessed their condition as good or fair, even those with proximal amputation or loss of 2 or 3 fingers. Our observations do not support replantation when only one of the second-to-fifth fingers have been amputated.

  10. Obesity and metabolic disorders in adults with lower limb amputation.

    Science.gov (United States)

    Kurdibaylo, S F

    1996-10-01

    Anthropometric and biochemical research was conducted on 94 subjects with various levels of lower limb amputation. The purpose of the work was to investigate the features of obesity progression and disorders of cholesterin metabolism, as well as to develop adequate training exercises. Anthropometric research was conducted by calipermetry; the biochemical research was done by various methods to determine exempt and total cholesterin and triglycerides in the blood serum. The research establishes the frequency of obesity progression relative to the level of amputation, as well as the features of the excessive body mass. Type 11A hyperlipoproteidemia was evident. It is characterized by rapid progress of atherosclerotic vascular disease and coronary disease (CD). Cyclic and acyclic exercises were developed for prophylaxis and therapy. Anthropometric research on the determination of body fat mass was conducted on 68 subjects with various levels of lower limb amputation. The nondirect method of measuring skin folds of several parts of the body was used to determine the extent of lipogenesis. Biochemical research of cholesterin metabolism was conducted on 26 subjects with lower limb amputation (a different group). Anthropometric research revealed an increase of body fat mass directly related to the level of amputation. The largest amount of fat in the body mass was noted for the subjects with bilateral transfemoral (above-knee) amputation or transfemoral plus transtibial (below-knee) amputation. Both groups averaged 25.9%. The body fat mass increased chiefly in the subcutaneous fat. Increase of the internal fat mass was less noticeable. The frequency of obesity progression in subjects with unilateral transtibial amputation equaled 37.9%; in subjects with transfemoral amputation, 48.0%; and in subjects with bilateral transfemoral or transfemoral plus transtibial amputation, 64.2%. Young subjects demonstrated obesity progression during the first year after amputation

  11. Microclimate buffering of winter temperatures by pine stumps in a temperate forest

    Science.gov (United States)

    Walczyńska, Aleksandra; Kapusta, Paweł

    2016-06-01

    In the presented study we evaluated the role of wood in buffering its inhabitants against winter temperatures. We followed the microscale temperature patterns inside and outside decaying pine stumps during two winter periods. We analyzed the data by extracting the minimum, maximum and mean temperatures for the episodes of snow, frost or no frost. We compared the temperature variation by applying an absolute values calculation (=modulus) for the subsequent measurements. Finally, we tested the buffering effect of the horizontal depth inside the stumps by comparing the pattern for 5 and 15 cm depths. The results show that (1) the minimum temperature was significantly higher inside than outside the stumps, while temperature variation tended to be larger outside than inside, (2) the dynamics of temperature varied between weather episodes, i.e. the periods characterized by the presence/absence of snow and of frost, (3) the minimum temperature inside the stumps increased with the horizontal depth, while temperature variation decreased. The results presented are the first truly microclimatic data on wood buffering and they are important for the understanding of the possible effects of climate change on the thermal relationships at the microscale.

  12. Invagination of the hernial sac stump. Technique for repair of inguinal hernia.

    Science.gov (United States)

    Shafik, A

    1980-09-01

    A technique for repair of indirect inguinal hernia is presented. The hernial sac stump is invaginated in an attempt to secure high ligation of the sac and obliterate any residual peritoneal diverticulum. Four hundred forty-two patients were operated on. The technique consists essentially of division of the internal spermatic fascial tube at the neck as well as embedding of the sac stump by purse-string sutures in a narrow neck of Lembert sutures in a wide neck. The defect in the fascia transversalis is closed over the stump. Three hundred eighty-one patients were followed up 2 to 15 years, with a recurrence rate of 1.6 percent. The concept that in indirect hernia the problem involves the sac rather than the defect is put forward. Recurrence results essentially from the existence of a handmade sac rather than an improperly repaired defect. The role of invagination of the sac in securing complete excision of the sac and proper closure of the defect is discussed. In initiating recurrence, the part played by the redundant peritoneum deep to the internal ring is emphasized. Changes in the dynamics of intraabdominal tension induced by stump embedding are explained.

  13. Effects of covering highland banana stumps with soil on banana weevil Cosmopolites sordidus (Coleoptera: Curculionidae) oviposition

    NARCIS (Netherlands)

    Masanza, M.; Gold, C.S.; Huis, van A.; Ragama, P.E.

    2005-01-01

    The effect of covering post-harvest banana stumps with soil on banana weevil Cosmopolites sordidus (Germar) oviposition levels was investigated at three locations, Sendusu, Kawanda Agricultural Research Institute (KARI) and Ntungamo district of southwestern Uganda. In the first experiment ovipositio

  14. The neuroma-like structure of the long-time severed and isolated nerve stumps

    Directory of Open Access Journals (Sweden)

    Eros Abrantes Erhart

    1965-06-01

    Full Text Available The long-time severed and isolated intermediate and distal nerve segments, maintained undisturbed in their connective tissue bed, completely separated from each other and from the proximal stump, are repopulated by nerve-fibres which origin is still unknown. The extremities of such nerve segments present complex nervous nodules capped by fibrous tissue, neuroma-like structures.

  15. Influence of tree provenance on biogenic VOC emissions of Scots pine (Pinus sylvestris) stumps

    Science.gov (United States)

    Kivimäenpää, Minna; Magsarjav, Narantsetseg; Ghimire, Rajendra; Markkanen, Juha-Matti; Heijari, Juha; Vuorinen, Martti; Holopainen, Jarmo K.

    2012-12-01

    Resin-storing plant species such as conifer trees can release substantial amounts of volatile organic compounds (VOCs) into the atmosphere under stress circumstances that cause resin flow. Wounding can be induced by animals, pathogens, wind or direct mechanical damage e.g. during harvesting. In atmospheric modelling of biogenic VOCs, actively growing vegetation has been mostly considered as the source of emissions. Root systems and stumps of resin-storing conifer trees could constitute a significant store of resin after tree cutting. Therefore, we assessed the VOC emission rates from the cut surface of Scots pine stumps and estimated the average emission rates for an area with a density of 2000 stumps per ha. The experiment was conducted with trees of one Estonian and three Finnish Scots pine provenances covering a 1200 km gradient at a common garden established in central Finland in 1991. VOC emissions were dominated by monoterpenes and less than 0.1% of the total emission was sesquiterpenes. α-Pinene (7-92% of the total emissions) and 3-carene (0-76% of the total emissions) were the dominant monoterpenes. Proportions of α-pinene and camphene were significantly lower and proportions of 3-carene, sabinene, γ-terpinene and terpinolene higher in the southernmost Saaremaa provenance compared to the other provenances. Total terpene emission rates (standardised to +20 °C) from stumps varied from 27 to 1582 mg h-1 m-2 when measured within 2-3 h after tree cutting. Emission rates decreased rapidly to between 2 and 79 mg h-1 m-2 at 50 days after cutting. The estimated daily terpene emission rates on a hectare basis from freshly cut stumps at a cut tree density of 2000 per ha varied depending on provenance. Estimated emission ranges were 100-710 g ha-1 d-1 and 137-970 g ha-1 d-1 in 40 and in 60 year-old forest stands, respectively. Our result suggests that emission directly from stump surfaces could be a significant source of monoterpene emissions for a few weeks after

  16. Prosthetic installation and training for the bilateral transfemoral amputation caused by Wenchuan earthquake%双侧大腿截肢患者的假肢装配和使用训练

    Institute of Scientific and Technical Information of China (English)

    武继祥; 周贤丽; 刘青山; 汪琴; 尹清; 林永辉; 刘宏亮; 吴宗耀

    2008-01-01

    目的 促进截肢患者早日掌握假肢使用方法 .方法 对3例截肢患者术后进行系统康复干预,同时针对假肢装配,使用方法 进行强化性训练.结果 3例截肢患者残肢创面均全部愈合,残肢端呈圆柱状,残肢肌力为5级,残肢髋关节活动范围正常,装配双侧大腿假肢后均取到满意的似肢使用疗效.结论 通过进行系统康复治疗、假肢装配及假肢使用训练后,双侧人腿截肢患者均能取得满意假肢使用效果,具有较高的独立生活能力,从而促其早日回归家庭及社会.%Obiective To help bilateral transfemoral amputee using prosthetic limb early.Methods Three bilateral transfemoral amputees were treated with physical therapy,stump moulding,kinesiotherapy,and prosthetic rehabilitation and installed with prosthetic limbs.Results The stump ulcer healed.The stump shape were cylinder.The muscle strength of stump reached the 5th grade.The range of motion of hip was normal.Three bilateral transfemoral amputees were installed with prosthetic limbs and trained with prosthetic management.Conclusion After systematic rehabilitation,prosthetic installation and training the individuals with bilateral transfemoral amputation can successfully ambulate and independently live.

  17. Carbon and nitrogen pools and mineralization rates in boreal forest soil after stump harvesting

    Science.gov (United States)

    Kaarakka, Lilli; Hyvönen, Riitta; Strömgren, Monika; Palviainen, Marjo; Persson, Tryggve; Olsson, Bengt A.; Helmisaari, Heljä-Sisko

    2016-04-01

    The use of forest-derived biomass has steadily increased in the Finland and Sweden during the past decades. Thus, more intensive forest management practices are becoming more common in the region, such as whole-tree harvesting, both above- and belowground. Stump harvesting causes a direct removal of carbon (C) in the form of biomass from the stand and can cause extensive soil disturbance, which in turn can result in increased C mineralization. In this study, the effects of stump harvesting on soil C and nitrogen (N) mineralization, and soil surface disturbance were studied at two different clear-felled Norway spruce (Picea abies) stands in Central Finland. The treatments were conventional stem-only harvesting combined with mounding (WTH) and stump harvesting (i.e. complete tree harvesting) combined with mounding (WTH+S). Logging residues were removed from all study sites. Soil samples down to a depth of 20 cm were systematically collected from the different soil disturbance surfaces (undisturbed soil, the mounds and the pits) 12-13 years after final harvest. Soil samples were incubated in the laboratory to determine the C and N mineralization rates. In addition, total C and N pools were estimated for each disturbance class and soil layer. Soil C and N pools were lower following stump harvesting, however, no statistically significant treatment effect was detected. Instead, C mineralization responses to treatment intensity was site-specific. C/N-ratio and organic matter content were significantly affected by harvest intensity. The observed changes in C and N pools appear to be related to the intrinsic variation of the surface disturbance and soil characteristics, and harvesting per se, rather than treatment intensity. Long-term studies are however needed to draw long-term conclusions whether stump harvesting significantly changes soil C and nutrient dynamics.

  18. Estimation of amputation level with a laser Doppler flowmeter

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Jørgensen, J P; Vollmer-Larsen, B;

    1989-01-01

    Leg amputation levels were decided in 24 patients suffering from atherosclerosis, using the conventional techniques of segmental blood pressure and radioisotope skin clearance. The skin microcirculation was measured and recorded before operation with a laser doppler flowmeter. A high correlation...

  19. Vascular surgery reduces the frequency of lower limb major amputations

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Bøvling, Søren; Fasting, H;

    1994-01-01

    In June 1988 a Department of Vascular Surgery was established in the county of Viborg, Denmark. In this retrospective study of the periods 1986-87 and 1989-90, we have observed a significant rise in the number of patients evaluated by a vascular surgeon before amputation, from 19 to 49...... surgical activity. The frequency of major amputations in the county in 1986-87 of 40.9 per 100,000 per year declined by 25% to 30.9 per 100,000 per year in 1989-90. We conclude that vascular surgery reduces the number of major lower limb amputations and consequently all patients threatened with amputation......%. At the same time the number of major lower limb amputations significantly decreased. This reduction was most marked in 1990 probably due to a rise of 43% in the number of distal reconstructions. The distribution between below knee, through knee and mid-thigh amputation was unaffected by the increased vascular...

  20. Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

    Directory of Open Access Journals (Sweden)

    Mi Sun Jung

    2012-07-01

    Full Text Available Background First suggested by Brent in 1979, the pocket principle is an alternative methodfor patients for whom a microsurgical replantation is not feasible. We report the successfulresults of a modified palmar pocket method in adults.Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantationusing palmar pocketing. All patients were adults who sustained a complete fingertip amputationfrom the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crushor avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmarpocketing method following a composite graft in these patients and prepared the pocket in thesubcutaneous layer of the ipsilateral palm.Results Of a total of 10 cases, nine had complete survival of the replantation and one had20% partial necrosis. All of the cases were managed to conserve the fingernails, which led toacceptable cosmetic results.Conclusions A composite graft and palmar pocketing in adult cases of fingertip injuryconstitute a simple, reliable operation for digital amputation extending from the tip to thelunula. These methods had satisfactory results.

  1. Comparison of Some Chemical Contents of Ganoderma lucidum (Curtis P. Karst Collected from Nature and Cultured on Orange Stump

    Directory of Open Access Journals (Sweden)

    Nezahat Turfan

    2016-03-01

    Full Text Available Ganoderma lucidum (Curtis P. Karst (Reishi mushroom is one of medicinal mushroom species. The chemical content of the mushrooms shows significant changes depending on the physical and chemical properties of their growing place. In this study; total soluble protein, total soluble carbohydrate (glucose, fructose and sucrose and some mineral elements (P, K, Mg, Mn, S, Fe, Zn, Ca and Na of Ganoderma lucidum collected from the nature and cultured on orange stump were investigated. According to the results; total protein, glucose, fructose, sucrose and starch content of the G. lucidum cultured on orange stump were found higher than G. lucidum collected from nature. Phosphorus, iron, sodium, potassium and sulfur content were determined to be higher in mushroom samples cultured on orange stump. Calcium, magnesium, manganese and zinc values were found as higher in mushroom samples collected from nature. According to these results, G. lucidum cultured on orange stump had higher nutritional value than mushrooms collected from nature.

  2. FDG uptake at the bronchial stump after curative lobectomy for non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Keyzer, Caroline; Corbusier, Florence; Kyratzi, Eirini; Gevenois, Pierre Alain [Universite libre de Bruxelles, Department of Radiology, Hopital Erasme, Brussels (Belgium); Sokolow, Youri [Universite libre de Bruxelles, Department of Thoracic Surgery, Hopital Erasme, Brussels (Belgium); Goldman, Serge [Universite libre de Bruxelles, Department of Nuclear Medicine, Hopital Erasme, Brussels (Belgium)

    2016-05-15

    Focal areas of FDG uptake may occur at the bronchial stump following curative lobectomy for non-small-cell lung carcinoma (NSCLC), even in the absence of suspicious CT changes. The purpose of our study was to investigate the significance of such PET/CT findings. FDG-PET/CT scans performed in 54 patients after lobectomy for NSCLC were reviewed. The presence of focal areas of FDG uptake at the bronchial stump, associated CT abnormalities, SUVmax, and normalized SUV (SUVnorm = SUVmax/mean liver SUV) were recorded. Final diagnosis was based on biopsy or imaging follow-up. Focal areas of FDG uptake at the bronchial stump were detected in 30 patients (56 %). Mean SUVmax was 4.0 ± 1.9 (range; 2.2-12.1) and mean SUVnorm was 1.8 ± 0.8 (range; 0.9-4.5). Biopsy showed recurrence in two patients. In these patients, SUVnorm was respectively 4.4 and 4.5 (with SUVmax of 8.8 and 12.1), whereas SUVnorm was lower than 4.0 in those without recurrence, with mean SUVnorm of 1.6 ± 0.5 (range; 0.9-3.4) and mean SUVmax of 3.6 ± 0.9 (range; 2.2-5.8). The CT component of the PET/CT revealed ill-defined peribronchial soft tissue opacity only in both patients with recurrence. FDG uptake at the bronchial stump is a frequent finding after pulmonary lobectomy. Moderate levels of FDG uptake (i.e., SUVnorm < 4.0) without corresponding abnormal CT findings might be a dual criterion for diagnosing benign post-surgical changes. (orig.)

  3. The Biocontrol Agent Phlebiopsis gigantea: Efficacy and Impacts on the Stump Bacterial Biota and Conifer tree Defences

    OpenAIRE

    Sun, Hui

    2011-01-01

    Phlebiopsis gigantea has been for a long time known as a strong competitor against Heterobasidion annosum and intensively applied as a biological control agent on stump surfaces of Picea abies in Fennoscandia. However, the mechanism underlying its antagonistic activity is still unknown. A primary concern is the possible impact of P. gigantea treatment on resident non-target microbial biota of conifer stumps. Additional risk factor is the potential of P. gigantea to acquire a necrotrophic habi...

  4. Major limb amputations: A tertiary hospital experience in northwestern Tanzania

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-05-01

    Full Text Available Abstract Background Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. Methods This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. Results A total of 162 patients were entered into the study. Their ages ranged between 2–78 years (mean 28.30 ± 13.72 days. Males outnumbered females by a ratio of 2:1. The majority of patients (76.5% had primary or no formal education. One hundred and twelve (69.1% patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality

  5. Risk factors for major amputation in hospitalised diabetic foot patients.

    Science.gov (United States)

    Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung

    2016-03-01

    Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels. PMID:26478562

  6. The scope of amputations in a Nigerian teaching hospital.

    Science.gov (United States)

    Solagberu, B A

    2001-09-01

    In developing countries, amputations have been performed due to trauma and infections; whereas in developed counties, trauma, diabetes and peripheral vascular diseases are the usual indications. Current practice in Nigeria suggests a change of relative indications, hence, this study. A five-year (July 1994 to June 1999) review of amputation records from the medical records, operating theatre, wards and physiotherapy department was carried out retrospectively. Amputation types, age, sex and indications were analysed. Fifty-eight amputations were performed in 56 patients (47 males, nine females, M: F = 5.2 : 1, age range 7-70 years, mean 33.3 +/- S.D 18.2). There were 42 lower and 16 upper limbs. Trauma accounted for 48.3%; followed by diabetes (29.3%), tumours (12.1%), infections (8.6%) and one indeterminate cause (1.7%). There was bias for sex, age and type of extremity as trauma was the commonest indication in male patients aged 30 years and below (and in the upper limb) whereas diabetes predominated in female patients above 30 years (and in the lower limb). Infection, as an indication for amputation, has now become a rear guard indication. Diabetes, previously uncommon, now appears in the forefront. These findings call for early detection and aggressive management of diabetic foot lesions.

  7. Mycobionta of birch and birch stump roots and its possible effect on the infection by Armillaria spp. II.

    Directory of Open Access Journals (Sweden)

    Hanna Kwaśna

    2014-08-01

    Full Text Available This paper presents the differences in size and structure of mycobionta communities occurring in soil and on/i n roots of a 30 year-old birch and its stumps 2 years after cutting of the trees. Special attention was paid to the occurrence of Zygorhynchus moelleri and Trichoderma viride. The first species due to the metabolites produced may presumably stimulate the infection by Armlllaria. The second species is a well-known antagonist of Armillaria, Z. moelleri accounted only for 2.6, l.3 and 9.l % of the total number of isolates in rhizoplane as well as in the fine and thick roots of stumps, respectively. Trlchodcrma viride and T. virens were present in roots of Hve birch and its stumps only occasionally. The relatively big population of Mycelium radicis atrovirens- particularly in the fine roots of stumps is attributed to their high vitality and relatively lower level of root decomposition. It seems that the rate of stump root decomposilion does not favour their colonization by Z. moelleri and its supposed contribution in enhancing the infection by Armillaria might not be so distinct as on stumps of 49-year-old birches.

  8. Transmetatarsal Amputation: A Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Ryan McCallum

    2012-01-01

    Full Text Available Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH. We have reflected on the cases of 11 patients (12 feet and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.

  9. Preventing amputation in adults with diabetes: identifying the risks.

    Science.gov (United States)

    Thomas, Eleanor

    2015-06-01

    Good management of diabetes can reduce the risk of complications of the disease. When not well managed, diabetes is associated with the complications of heart disease, stroke, blindness, kidney disease and amputations. Diabetes can reduce the blood supply to the feet and cause a loss of feeling. As a result, foot injuries do not heal well and the person may not realise that their foot is sore or injured. Damage to the foot may lead to the development of foot ulcers, which if left untreated may result in amputation of the limb. Preventive care is a priority, but when complications occur the next step is to halt progression. Therefore, effective foot care and timely treatment of foot ulcers are important in preserving foot function and mobility, and preventing amputation in adults with diabetes. PMID:26036406

  10. Factors related to successful job reintegration of people with a lower limb amputation

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, Antje; Groothoff, JW; van Sonderen, E; Goeken, LN; Eisma, Willem

    2001-01-01

    Objective: To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. Design: Cross-sectional study. Setting: University hospital. Patients: Subjects had an acquired unilateral major amputati

  11. Multiple regeneration from axolotl limb stumps bearing cross-transplanted minced muscle regenerates : brief note

    NARCIS (Netherlands)

    Carlson, Bruce M.

    1975-01-01

    Flexor and extensor muscles in the upper arms of axolotls were minced and cross-transplanted. The limbs were amputated 5 and 30 days after mincing. In each experiment a high percentage of the regenerates consisted of multiple limbs. This demonstrates that the morphogenetic information which produces

  12. [Antibiotic treatment in patients amputated for ischemic diabetic foot].

    Science.gov (United States)

    Fernández Montequín, J I; McCook Martínez, J; Lima Santana, B; Velasco Armas, N; Montalvo Diago, J; Mahía Vilas, M

    1991-01-01

    Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment. PMID:1755544

  13. Amputated Lower Limb Fixation to the Fracture Table.

    Science.gov (United States)

    Gamulin, Axel; Farshad, Mazda

    2015-11-01

    Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table with fracture reduction obtained by traction and adequate rotation exerted on the slightly abducted extremity. Although rare, these fractures may occur on an amputated limb. If so, standard use of a fracture table is not possible. To address this situation, the authors describe a simple novel technique allowing rigid fixation of the amputated limb to the traction device of the fracture table that provides accurate control of reduction in all planes. PMID:26558660

  14. Reduced incidence of lower-extremity amputations in a Danish diabetes population from 2000 to 2011

    DEFF Research Database (Denmark)

    Jørgensen, M E; Almdal, T P; Faerch, K

    2014-01-01

    Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes.......Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes....

  15. The effects of rotation and positional change of stump tissues upon morphogenesis of the regenerating axolotl limb

    NARCIS (Netherlands)

    Carlson, Bruce M.

    1972-01-01

    Rotation of a skin cuff 180° around the proximodistal axis of the upper arm in the axolotl results in the formation of multiple regenerates in about 80° of cases after amputation of the limb through the rotated skin. Rotation of the dermis or the flexor and extensor muscles folowed by amputation pro

  16. Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison.

    Science.gov (United States)

    Demiralp, Bahtiyar; Ege, Tolga; Kose, Ozkan; Yurttas, Yuksel; Basbozkurt, Mustafa

    2014-05-01

    The purpose of this study is to compare the long-term clinical outcomes of patients who were treated with either hind foot reconstruction or amputation in complex hind foot injuries accompanied with bone and soft tissue loss due to land-mine explosions. Between 1994 and 2004, all patients with hind foot complex injuries due to land-mine explosion, who were operated in our clinic, were enrolled to the study. All patients were evaluated with Short-Form 36 (SF-36), Foot and Ankle Disability Index (FADI) and Body Image Quality of Life Inventory (BIQLI) after a mean of 15.1 ± 2.2 (range 9-19) years of follow-up. Demographic characteristics, number of operations, necessity of psychiatric treatment and all complications were compared between groups. There were a total of 42 patients [21 in reconstruction group (Gr I) and 21 in amputation group (Gr II)]. The mean age at the time of final follow-up was 38.4 ± 3.04 years in Gr I and 38.2 ± 4.24 years in Gr II (p = 0.732). The mean follow-up duration was 15.7 ± 2.07 years in Gr I and 14.57 ± 2.29 years in Gr II (p = 0.081). The number of operations was significantly higher in Gr I (8.66 ± 10.2 times vs. 4.42 ± 7.7 times, respectively, p = 0.001). The mean FADI score at the final follow-up was 64.3 ± 18.1 in Gr I. In amputation group, more patients needed psychotherapy due to major depression (12 patients vs. 4 patients, p = 0.012). Major complications in Gr I were musculocutaneous flap atrophy in calcaneal region (n = 8 patients), limited ankle motion (n = 11) and painful osteophytes on plantar region (n = 6). In Gr II, stump problems were dominating (pain and tenderness n = 10, ulcer n = 2, allergic skin lesions n = 7, painful neuroma n = 10, bony spur n = 5, paresthesia n = 1, excessive sweating n = 12). At the final visit, although SF-36 scores were similar between groups (p = 0.182), extremity reconstruction group had significantly higher BIQLI scores than the amputation group (p = 0.016). If the dorsalis pedis is

  17. Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sara L. Borkosky

    2012-01-01

    Full Text Available Diabetes mellitus with peripheral sensory neuropathy frequently results in forefoot ulceration. Ulceration at the first ray level tends to be recalcitrant to local wound care modalities and off-loading techniques. If healing does occur, ulcer recurrence is common. When infection develops, partial first ray amputation in an effort to preserve maximum foot length is often performed. However, the survivorship of partial first ray amputations in this patient population and associated re-amputation rate remain unknown. Therefore, in an effort to determine the actual re-amputation rate following any form of partial first ray amputation in patients with diabetes mellitus and peripheral neuropathy, the authors conducted a systematic review. Only studies involving any form of partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy but without critical limb ischemia were included. Our search yielded a total of 24 references with 5 (20.8% meeting our inclusion criteria involving 435 partial first ray amputations. The weighted mean age of patients was 59 years and the weighted mean follow-up was 26 months. The initial amputation level included the proximal phalanx base 167 (38.4% times; first metatarsal head resection 96 (22.1% times; first metatarsal-phalangeal joint disarticulation 53 (12.2% times; first metatarsal mid-shaft 39 (9% times; hallux fillet flap 32 (7.4% times; first metatarsal base 29 (6.7% times; and partial hallux 19 (4.4% times. The incidence of re-amputation was 19.8% (86/435. The end stage, most proximal level, following re-amputation was an additional digit 32 (37.2% times; transmetatarsal 28 (32.6% times; below-knee 25 (29.1% times; and LisFranc 1 (1.2% time. The results of our systematic review reveal that one out of every five patients undergoing any version of a partial first ray amputation will eventually require more proximal re-amputation. These results reveal that partial first ray

  18. Effects of season and urea treatment on infection of stumps of Picea abies by Heterobasidion annosum in stands on former arable land

    Energy Technology Data Exchange (ETDEWEB)

    Brandtberg, P.O. [Swedish Univ. of Agricultural Sciences, Uppsala (Sweden). Dept. of Ecology and Environmental Research; Johansson, Martin [Swedish Univ. of Agricultural Sciences, Uppsala (Sweden). Dept. of Forest Mycology and Pathology; Seeger, P. [Swedish Univ. of Agricultural Sciences, Uppsala (Sweden). Dept. of Statistics

    1996-09-01

    Between 1986 and 1990, a series of thinnings were made in previously unthinned first rotation stands on former arable land located in the southern half of Sweden. The aim was to evaluate the effects of season and urea treatment on the frequency of infection of stumps of Norway spruce (Picea abies (L.) Karst.) by the root-rot fungus Heterobasidion annosum (Fr.) Bref. Untreated stumps, resulting from 60 thinnings (22-100 stumps each, altogether ca 3000 stumps) made at different times of year, were investigated 3-24 months after cutting to determine whether they were infected with H. annosum. On average only 2% of the stumps from thinnings made in November-February were infected, whereas the incidence of infection among stumps thinned in June-July was 34%. Two methods of treating stumps with urea to prevent stump infection by H. annosum after thinning were evaluated in terms of effectiveness. The freshly cut stumps were treated with a 20% urea solution, transformed to a gel by adding 0.2% carboxymethyl cellulose, or with a 30% urea solution. On average, the reduction in infection rate obtained was 62% with the first method and 85% with the latter. In a separate study involving a concentration series of urea, there was a considerable drop in protection efficiency, from 89% to 58%, when the concentration was decreased from 30% to 15%. 38 refs, 3 figs, 1 tab

  19. Reduction of residual limb volume in people with transtibial amputation

    Directory of Open Access Journals (Sweden)

    Audrey T. Tantua, MD

    2014-11-01

    Full Text Available The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study was to analyze the reduction of residual limb volume in people with transtibial amputation and to correlate residual limb volume with residual limb circumference. In a longitudinal cohort study of 21 people who had a transtibial amputation, residual limb volume was measured using a laser scanner and circumference was measured using a tape measure 1 wk postamputation and every 3 wk thereafter until 24 wk postamputation. A linear mixed model analysis was performed with weeks postamputation transformed according to the natural logarithm as predictor. Residual limb volume decreased significantly over time, with a large variation between patients. Residual limb volume did not correlate well with circumference. On average, residual limb volume decreased 200.5 mL (9.7% of the initial volume per natural logarithm of the weeks postamputation. The decrease in residual limb volume following a transtibial amputation was substantial in the early postamputation phase, followed by a leveling off. It was not possible to determine the specific moment at which the residual limb volume stabilized.

  20. Take Care of Yourself After an Amputation or Other Surgery

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    This podcast provides health information for amputees on how to take care of yourself after an amputation or other surgery.  Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program.   Date Released: 2/18/2010.

  1. The incidence of symptomatic neuroma in amputation and neurorrhaphy patients

    NARCIS (Netherlands)

    van der Avoort, D. J. J. C.; Hovius, S. E. R.; Selles, R. W.; van Neck, J. W.; Coert, J. H.

    2013-01-01

    Purpose: The incidence of symptomatic neuroma in finger nerve injuries varies widely in the literature. In this retrospective study, we evaluated the incidence of symptomatic neuroma after repair of digital nerve injuries (neurorrhaphy) and after amputation of one or more fingers. We also determined

  2. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

    OpenAIRE

    Jandrić Slavica; Topić Brano

    2002-01-01

    The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ± 11.67 days a...

  3. Assessment of quality of life in patients after lower limb amputation

    Directory of Open Access Journals (Sweden)

    Knežević Aleksandar

    2015-01-01

    Full Text Available Introduction. Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. Material and Methods. The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND 36 - Item Health Survey 1.0 (SF - 36 was used to measure the quality of life. Results. The results showed that patients with lower extremity amputation scored lower than the control group on all SF- 36 variables (p0.05. Seventeen (61% patients were with transfemoral, and 11 (39% with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05. Conclusion. The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

  4. Pattern of injury in those dying from traumatic amputation caused by bomb blast.

    Science.gov (United States)

    Hull, J B; Bowyer, G W; Cooper, G J; Crane, J

    1994-08-01

    Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products. PMID:7953338

  5. Pattern of injury in those dying from traumatic amputation caused by bomb blast.

    Science.gov (United States)

    Hull, J B; Bowyer, G W; Cooper, G J; Crane, J

    1994-08-01

    Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products.

  6. Lower limb amputations: differences between the genders and long-term survival.

    Science.gov (United States)

    Heikkinen, M; Saarinen, J; Suominen, V P; Virkkunen, J; Salenius, J

    2007-09-01

    The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 - 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10(6) inhabitants/year) (p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes. PMID:17979013

  7. The Mass Loss and Humification of Stumps and Roots in Masson Pine Plantations Based on Log File Records.

    Science.gov (United States)

    Zhou, Jiao; Wu, Fuzhong; Yang, Wanqin; Tan, Bo; Xu, Zhenfeng; Zhang, Jian; Duan, Fei; Liu, Hui; Justine, Meta Francis

    2016-01-01

    Stumps account for a large proportion of coarse woody debris in managed forests, but their decay dynamics are poorly understood. The loss of mass and the degree of humification of the above-ground woody debris, below-ground woody debris, bark and root system (R1, 10 mm ≥ diameter > 0 mm; R2, 25 mm ≥ diameter >10 mm; 100 mm ≥ R3 > 25 mm; R4 > 100 mm) of Masson pine (Pinus massoniana) stump systems were evaluated in southwestern China in a chronosequence of plantations cut 1-15 years prior to the study. The results indicated that above-ground woody debris decomposed more quickly than below-ground woody debris and bark, whereas the degree of humification followed the opposite trend. Compared with one-year stumps, the mass losses of 15-year stump systems were 60.4% for above-ground woody debris, 42.1% for below-ground woody debris, 47.3% for bark, 69.9% for R1, 47.3% for R2, 51.0% for R3, and 83.2% for R4. In contrast, below-ground woody debris showed a greater degree of humification compared with other components in the stump system. Among the root system, fine roots (R1, diameter ≤ 10 mm) had the largest k value (0.09), whereas the decay rate of coarser roots (R2, R3, R4; diameter > 10 mm) increased with increasing root diameter. However, coarse roots showed a larger degree of humification (0.2-0.6) than fine roots (0.3-0.4). These results suggest that below-ground woody debris and coarse roots may display a higher degree of humification, showing greater short-term contributions to overall humification when compared with the other components in the stump system.

  8. Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

    Institute of Scientific and Technical Information of China (English)

    LI Yong-dong; HAN Xin-wei; WU Gang; LI Ming-hua

    2007-01-01

    Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula (BSF). Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types (A and B) of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7(87.5%) of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple,safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. (J Intervent Radiol, 2007, 16: 253-257)[ Key words ] Fistula, pulmonary; Bronchialpleural fistula; Stents and prostheses; Computed tomography

  9. Considerations on risk factors correlated to the occurrence of gastric stump cancer.

    Science.gov (United States)

    Păduraru, D N; Nica, A; Ion, D; Handaric, M; Andronic, O

    2016-01-01

    Gastric stump cancer (GSC) is the malignant tumor that develops in the gastric remnant after partial gastrectomy was performed both for benign and malignant lesions. This paper presents the results of the case studies from the scientific literature, which focused on GSC, and has been published in the last 10 years. The search was performed with the help of the specific tools offered by the international databases. The subject was approached because of the constant rising incidence of GSC in the past few years, now reaching values between 1% and 7%. The outcome report is consistent and similar to the period that ended approximately 25 years ago, when general surgeons dedicated a significant part of their activity to treating gastric ulcer. Statistics revealed that the main risk factors are the following: the type of reconstruction after distal gastrectomy (Billroth I or Billroth II), the presence of duodenogastric reflux, the time between gastric resections, and the moment of diagnosis of gastric stump cancer, the initial pathology for which partial gastrectomy was performed, gender, age, helicobacter pylori infection, Epstein Barr virus infection and the presence of vagotomy. All the authors have significantly contributed to the article and have been involved in the writing of the manuscript in draft and any revision stages, and have read and approved the final version. PMID:27453741

  10. JRRD Then & Now: Commentary on Troedsson’s 1964 article "Stump arterial circulation and its relationship to the prescription of a prosthesis for the geriatric patient"

    Directory of Open Access Journals (Sweden)

    Joan E. Sanders, PhD

    2013-08-01

    Full Text Available hough the reasons for amputation since 1964 have shifted from primarily disease (93% disease, 5% trauma [1] to a closer balance between disease and trauma (55% disease, 45% trauma [2], a major challenge faced by the amputation surgeon continues to be selection of the appropriate level of amputation.

  11. JRRD Then & Now: Commentary on Troedsson’s 1964 article "Stump arterial circulation and its relationship to the prescription of a prosthesis for the geriatric patient"

    OpenAIRE

    Joan E. Sanders, PhD

    2013-01-01

    hough the reasons for amputation since 1964 have shifted from primarily disease (93% disease, 5% trauma) [1] to a closer balance between disease and trauma (55% disease, 45% trauma) [2], a major challenge faced by the amputation surgeon continues to be selection of the appropriate level of amputation.

  12. 自制残肢伤口固定套在截肢患者中的应用%Application of homemade stump wound fixed sets for amputees

    Institute of Scientific and Technical Information of China (English)

    唐翠; 许月萍; 王刚

    2014-01-01

    目的:利用自制残肢伤口固定套固定残肢伤口,探讨其临床应用效果。方法选择急诊行截肢手术的肢体毁损伤患者68例,随机分为观察组35例,术后利用自制残肢伤口固定套固定;对照组33例采用敷料外U型石膏固定。比较两组患者术后伤口引流量、局部肿胀程度、残肢皮肤压疮、伤口感染、邻近关节活动功能情况。结果观察组感染率为5.71%,皮肤压疮坏死率为8.57%,肿胀发生率为28.57%,均低于对照组(18.18%,15.15%,54.55%),差异有统计学意义(χ2值分别为3.810,3.340,4.790;P<0.05)。观察组患者术后伤口引流量为(46.80±12.35) ml,邻近关节活动度为(145.68±13.20)°,对照组分别为(89.81±10.61)ml,(112.46±9.21)°,两组比较差异有统计学意义(t值分别为24.721,11.330;P<0.05)。结论利用自制残肢伤口固定套固定残肢伤口,能减少伤口术后出血,促进肿胀消退,减少皮肤压疮,有利于早期邻近关节功能锻炼。%Objective To discuss the clinical effect of homemade stump wound fixed sets for amputees. Methods From January 2010 to November 2013 we treated sixty eight cases of patients with smashed wound, who received emergency amputation surgery.We randomly selected thirty five cases of using homemade stump wound fixed sets as experimental group, and chosenthirty three cases of using the U-shaped plaster dressingmethodto dress outside wound as control group, comparing two groups with postoperative wound drainage, local swelling, stump skin pressure sores, wound infection, joint function close to the situation. Results In the experimental group, the infection rate was 5.71%, skin necrosis rate 8.57%, incidence of swelling 28.57%,while those rate in the control group were 18.18%,15.15% and 54.55% respectively, the differences were statistically signifcant (χ2 =3

  13. Bronchial stump aspergillosis after lobectomy for lung cancer as an unusual cause of false positive fluorodeoxyglucose positron emission tomography and computed tomography: a case report

    Directory of Open Access Journals (Sweden)

    Font Albert

    2011-02-01

    Full Text Available Abstract Introduction Bronchial stump aspergillosis is a rare entity characterized by cough and hemoptysis. Case presentation We report the case of a 58-year-old Caucasian woman who developed bronchial stump aspergillosis two years after a left upper lobe resection for lung cancer. Bronchial stump aspergillosis was diagnosed as a result of a focus of increased fluorodeoxyglucose activity in a follow-up positron emission tomography and computed tomography scan. She was treated with oral antifungal therapy and presented with good evolution after three months of treatment. Conclusion Bronchial stump aspergillosis is an unusual complication after pulmonary resection. Clinicians should be aware of it when a local recurrence of cancer around the bronchial stump is suspected based on a positive positron emission tomography and computed tomography finding.

  14. Epidemiology of post-traumatic limb amputation: a National Trauma Databank analysis.

    Science.gov (United States)

    Barmparas, Galinos; Inaba, Kenji; Teixeira, Pedro G R; Dubose, Joseph J; Criscuoli, Michele; Talving, Peep; Plurad, David; Green, Donald; Demetriades, Demetrios

    2010-11-01

    The purpose of this study was to examine the epidemiology and outcomes of posttraumatic upper (UEA) and lower extremity amputations (LEA). The National Trauma Databank version 5 was used to identify all posttraumatic amputations. From 2000 to 2004 there were 8910 amputated patients (1.0% of all trauma patients). Of these, 6855 (76.9%) had digit and 2055 (23.1%) had limb amputation. Of those with limb amputation, 92.7 per cent (1904/2055) had a single limb amputation. LEA were more frequent than UEA among patients in the single limb amputation group (58.9% vs 41.1%). The mechanism of injury was blunt in 83 per cent; most commonly after motor vehicle collisions (51.0%), followed by machinery accidents (19.4%). Motor vehicle collision occupants had more UEA (54.5% vs 45.5%, P < 0.001), whereas motorcyclists (86.2% vs 13.8%, P < 0.001) and pedestrians (91.9% vs 8.1%, P < 0.001) had more LEA. Patients with LEA were more likely to require discharge to a skilled nursing facility; whereas those with UEA were more likely to be discharged home. Traumatic limb amputation is not uncommon after trauma in the civilian population and is associated with significant morbidity. Although single limb amputation did not impact mortality, the need for multiple limb amputation was an independent risk factor for death.

  15. Epidemiological Study on Reasons for Leg Amputation in Japanese

    OpenAIRE

    Hayashi, Yoshitaka; IMAKI, Masahide; Ogawa, Yukiko; FUCHOKA, Satoshi; OKUDA, Kuniharu

    2006-01-01

    This study was conducted, with special reference to elucidating the causes for lower limb amputation, which would have the most significant effect on "locomotion", the basis of independence of the aged. The subjects were leg amputees for whom artificial limbs had been fitted financed by various insurance policies in Osaka prefecture. The survey was conducted on 3, 138 subjects, from whom acceptable responses were obtained from 1, 460 (recovery rate, 46.5%). Questionnaires were mailed to each ...

  16. Classifying prosthetic use via accelerometry in persons with transtibial amputations

    Directory of Open Access Journals (Sweden)

    Morgan T. Redfield, MSEE

    2013-12-01

    Full Text Available Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor, record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+ was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing, standing (i.e., standing upright with limited leg motion, or sitting (i.e., seated with limited leg motion. Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/– standard deviation accuracy of 96.6% +/– 3.0%.

  17. Classifying prosthetic use via accelerometry in persons with transtibial amputations.

    Science.gov (United States)

    Redfield, Morgan T; Cagle, John C; Hafner, Brian J; Sanders, Joan E

    2013-01-01

    Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor), record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+) was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing), standing (i.e., standing upright with limited leg motion), or sitting (i.e., seated with limited leg motion). Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/- standard deviation accuracy of 96.6% +/- 3.0%.

  18. Exploring ethical justification for self-demand amputation.

    Science.gov (United States)

    Tomasini, Floris

    2006-01-01

    Self-demand amputees are persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves. They want to rid themselves of a limb that they believe does not belong to their body-identity. The obsessive desire to have appendages surgically removed to fit an alternative body-image is medically and ethically controversial. My purpose in this paper is to provide a number of normative and professional ethical perspectives on whether or not it is possible to justify surgery for self-demand amputees. In doing so I proceed dialogically, moving between empirical context and normative theory, revealing the taken for granted normative assumptions (what I call the natural attitude--a technical term borrowed from phenomenology) that provide ethical limits to justifying the treatment of self-demand amputees. While I critically examine both Kantian responses against as well as Utilitarian responses for amputation on demand, I conclude that neither normative tradition can fully incorporate an understanding of what it is like to be a self-demand amputee. Since neither theory can justify the apparent non-rational desire of amputation on demand, ethical justification, I argue, falls short of the recognition that there may be a problem. To end, I introduce a meta-ethical idea, "the struggle for recognition," opening up the theoretical possibility of a hermeneutics of recognition before ethical justification that may be more sensitive to the problem of radical embodied difference exemplified by self-demand amputees.

  19. What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

    Directory of Open Access Journals (Sweden)

    Lazzarini Peter A

    2012-05-01

    Full Text Available Abstract Background Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations. Methods Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197. All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p  Results One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%, peripheral arterial disease (non-diabetes (18%, trauma (8%, type 1 diabetes (7% and malignant tumours (5%. Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p  Conclusions This study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have

  20. Sensación de miembro fantasma y dolor de miembro residual tras 50 años de la amputación Chronic phantom sensation and residual limb pain 50 years after amputation

    Directory of Open Access Journals (Sweden)

    J. Olarra

    2007-08-01

    Full Text Available Introducción El dolor del miembro residual o dolor de muñón es aquel que aparece en la parte todavía existente de la extremidad amputada. Paciente: Presentamos el caso de un paciente varón de 74 años con antecedentes de amputación supracondílea postraumática del miembro inferior izquierdo, que desarrolló dolor de miembro residual y sensación de miembro fantasma 50 años después de la amputación sin una causa que Justificara su aparición. El tratamiento con antidepresivos tricíclicos (amitriptilina, anticonvulsivantes (gabapentina y tramadol permitió un buen control del dolor. Conclusiones: La existencia de una matriz neuronal determinada genéticamente pero modulada durante la vida por los impulsos nerviosos (nociceptivos, crearía una memoria somato-sensorial que sería responsable de la aparición del dolor de miembro fantasma.Background and objective: Residual limb pain or stump pain is defined as pain in the remaining part of an amputated limb. Patient: We present the case of a 74-year-old male patient with a history of posttraumatic transfemoral (above knee amputation of the left lower limb who developed residual limb pain and phantom limb sensation 50 years after amputation without a clear etiology. Treatment with tricyclic antidepressants (amitriptyline, anticonvulsivants (gabapentin and opioids (tramadol, provided a satisfactory control of pain. Conclusions: The existence of a neuromatrix initially determined genetically and later sculpted by sensory inputs (continuous nociceptive stimulation, could create what is known as the somatosensorial memory, responsible for the development of phantom limb pain.

  1. Clinical effect and necessity of interventional treatment in diabetic foot before and after amputation

    International Nuclear Information System (INIS)

    Objective: To assess the clinical effect and necessity of interventional treatment in diabetic foot before and after amputation. Methods: Combined intravascular angioplasty with intraarterial medicine perfusing were carried out in fourteen patients with diabetic foot including 10 patients treated before amputation and 4 after amputation involving superficial femoral, deep femoral, tibial and fitular arteries. Among them seventeen vessels with irregular stenosis and obstruction were treated by intravascular angioplasty through balloon dilation. Results: The technical successful rate was 100%, no complication happened. The symptoms were relieved in all patients after treatment, including promotion of lower extremity arterial blood perfusion, reducing range of amputation and wound healing after amputation. Conclusions: Intravascular interventional treatment is safe, effective and valuable in diabetic foot before and after amputation. (authors)

  2. Hip Arthroscopy in Patients With Lower-Extremity Amputations: Patient Positioning and Traction Technique.

    Science.gov (United States)

    McCabe, Michael P; Davila, Jeffrey

    2015-12-01

    Improved battlefield survival rates have resulted in a significant number of young active patients with lower-extremity amputations. Because of the increased demands placed on their hips, patients with amputations may be more susceptible to the sequelae of hip pathology and femoroacetabular impingement. Arthroscopic management of hip pathology may be successfully performed in patients with ipsilateral, contralateral, or bilateral lower-extremity amputations. We describe our experience in this unique patient population. A technique for secure patient positioning that provides sufficient countertraction in the case of contralateral amputation is described, as is the use of skeletal traction with a temporary external fixator for joint distraction in patients with ipsilateral amputations. Considerations specific to patients with high transfemoral amputations are discussed as well. PMID:27284510

  3. Substantial reduction in the number of amputations among patients with diabetes

    DEFF Research Database (Denmark)

    Rasmussen, Benjamin S B; Yderstraede, Knud B; Carstensen, Bendix;

    2016-01-01

    as well as the incidence of further amputations, subdivided by level of amputation. RESULTS: During the period 1996-2011, a total of 2,832 amputations were performed, of which 1,285 were among patients with diabetes and 1,547 among individuals without diabetes. Relative to persons without diabetes......, patients with diabetes had an HR for below-ankle amputations (BAAs) of 14.7 for men and 7.5 for women, and for from-ankle-to-knee amputations (BKAs) of 7.6 and 8.4 for men and women, respectively. For above-knee amputations (AKAs) the numbers were 4.0 for men and 3.7 for women. We found an annual reduction...

  4. Computer simulation of flow and mixing at the duodenal stump after gastric resection

    Institute of Scientific and Technical Information of China (English)

    Nenad Filipovic; Aleksandar Cvetkovic; Velibor Isailovic; Zoran Matovic; Mirko Rosic; Milos Kojic

    2009-01-01

    AIM: To investigate the flow and mixing at the duodenal stump after gastric resection, a computersimulation was implemented.METHODS: Using the finite element method, two different Billroth ? procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity,pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.RESULTS: The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. Case A had a more favorable pressure distribution in comparison with case B.However, case B had better performance in terms of food transport because of more continual fooddistribution,as well as better emptying of the duodenal section.

  5. Pyovagina and stump pyometra in a neutered XX sex-reversed Beagle: a case report

    International Nuclear Information System (INIS)

    An 18-month-old, neutered male beagle presented with acute abdominal signs and a suppurative infection of the urogenital tract. Chromosomal sex was female (78, XX), gonadal sex was male (testicles), and phenotypic sex was ambiguous, with evidence of both male and female duct systems. The internal and external genitalia consisted of epididymides, an underdeveloped uterus with an immature spermatic cord, communication between the uterus or cranial vagina and the membranous urethra, a urethrographically male urethra, a hypoplastic os penis, and a hypoplastic penis with hypospadia. Based on these findings and the familial history of a similarly affected litter mate, the dog was diagnosed as having the XX male syndrome with pyovagina and uterine stump pyometra. Radiographic and ultrasonographic investigations are described, and abnormalities of chromosomal sex, gonadal sex, and phenotypic sex are discussed

  6. Apendicitis del muñón apendicular Appendicitis of the appendicular stump

    Directory of Open Access Journals (Sweden)

    María Carolina Berrogain

    2012-03-01

    Full Text Available La apendicitis del muñón es una entidad rara, caracterizada por un proceso inflamatorio del remanente apendicular luego de una apendicectomía incompleta. Los signos y síntomas no difieren de una apendicitis aguda. Al no ser una patología usualmente pensada como posible diagnóstico diferencial del abdomen agudo inflamatorio, tiene mayor riesgo de complicaciones y morbi-mortalidad. Los métodos seccionales de diagnósticos por imágenes resultan muy beneficiosos para definir el diagnóstico. La ultrasonografía (US y tomografía computada (TC demuestran signos similares a los observados en cuadros habituales de inflamación aguda del apéndice cecal. Se presentan dos casos de apendicitis del muñón, uno de ellos recibió tratamiento quirúrgico y el otro tratamiento médico.Stump appendicitis is a rare entity characterized by inflammation of the appendiceal remanent after incomplete appendectomy. Signs and symptoms do not differ from acute appendicitis. As it is not a condition usually considered as a potential differential diagnosis of acute inflammatory abdomen, it has higher risks of complications and morbidity and mortality. Imaging methods are highly useful to define the diagnosis. Ultrasound (US and Computed Tomography (CT show signs similar to those found in standard cases of acute appendicitis. Two cases of stump appendicitis are reponed: one managed with surgical treatment and the other with medical treatment.

  7. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

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    Ramkumar Nirupama

    2005-03-01

    Full Text Available Abstract Background Surgical treatment of peripheral vascular disease (PVD in dialysis patients is controversial. Methods We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. Results Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896 or amputation (n = 2,046 in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR 19.0, 95% CI (confidence interval 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71 in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (rd percentile of propensity score and moderate likelihood of amputation (33rd to 66th percentile but not in high likelihood group (>66th percentile. The number of hospital days in the amputation and revascularization groups was not different. Conclusion Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

  8. Evaluation of variations of neck to shaft of femur in amputations above knee

    OpenAIRE

    Naraghi M; Hedayatpoor A

    1997-01-01

    In this study, we investigated variations of the angle between neck and shaft of femur after amputation of tigh above the knee. In amputated tigh the angle between neck and shaft of the femur is decreased than normal (nearly 90° degrees) (coax vara). The angle of the normal femur usually increases due to weight bearing (coax valga). In the patients that both tighs have been amputated the changes of the angle are equal.

  9. Evaluation of variations of neck to shaft of femur in amputations above knee

    Directory of Open Access Journals (Sweden)

    Naraghi M

    1997-09-01

    Full Text Available In this study, we investigated variations of the angle between neck and shaft of femur after amputation of tigh above the knee. In amputated tigh the angle between neck and shaft of the femur is decreased than normal (nearly 90° degrees (coax vara. The angle of the normal femur usually increases due to weight bearing (coax valga. In the patients that both tighs have been amputated the changes of the angle are equal.

  10. The morphology and functions of the muscles around the hip joint after a unilateral transfemoral amputation

    OpenAIRE

    Jaegers, Sonja Maria Héléne José

    1993-01-01

    This dissertation is concerned with the consequences of a transfemoral amputation for the morphology and functions of the muscles around the hip joint. Knowledge about and insight into the changes appearing in the morphology and functions of the hip muscles of transfemoral amputees are important to amputation surgery as well as to prosthetics. Amputation surgery and prosthetics are interrelated and cannot be separated one from another. .... Zie: Summary

  11. A Clinical and Histological Analysis of Mesenchymal Stem Cells in Amputation

    Science.gov (United States)

    2016-07-20

    Ischemia; Peripheral Arterial Disease; Peripheral Vascular Disease; Vascular Disease; Arterial Occlusive Disease; Arteriosclerosis; Atherosclerosis; Cardiovascular Disease; Pathologic Processes; Orthopedic Procedures; Amputation

  12. Reducing treatment by means of physical rehabilitation after lower limb amputation

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    Liana Dugina

    2015-04-01

    Full Text Available Purpose: the main approaches to the assignment of physical rehabilitation restorative treatment after lower limb amputations. Material and Methods: theoretical analysis and synthesis of modern scientific and methodological literature data on methods of comprehensive rehabilitation after lower limb amputations. Results: the features of the application of physical rehabilitation after lower limb amputations, tasks and presents the main approaches to the appointment of medical physical training, therapeutic massage and physical therapy in preparation for prosthetics. Conclusions: demonstrated that therapeutic physical training, therapeutic massage and physical therapy are effective means of physical rehabilitation of patients after lower limb amputations.

  13. Analysis of 24 Patients Who Were Amputated Due to a Malignant Tumor in the Skeleton

    Directory of Open Access Journals (Sweden)

    Hasan Gocer

    2014-11-01

    Full Text Available Aim: The purpose of the study was to assess the cases that were amputated in our clinic due to primary malignant and metastatic bone and soft tissue tumor. Material and Method: 24 cases that were amputated due to primary malignant and metastatic bone and soft tissue tumor between January 1987 and January 2012 were examined retrospectively. The cases were assessed in terms of age, gender, pathological diagnosis, localization, type of amputation, survival and characteristics. The data obtained were transferred to SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with Shapiro-Wilk test. Results: Of the 24 cases, 17 (70% were men, while 7 (30% were women and the average age was 42 (between 12 and 68. The most common reasons for amputation were skin cancer (25%, Ewing sarcoma (20.8%, Osteosarcoma (16.6% and others (Malignant mesenchymal tumor, chondrosarcoma, synovial sarcoma, metastatic tumor. 16 of these patients had previously received an intervention in a different centre at least once. The most common type of amputation was above-knee amputation (58.3%, below-knee amputation (25% and others (hip disarticulation, below-elbow amputation. 8 patients were found to have skin problems and debridement was performed on 6. 14 cases died within the postoperative first year. Discussion: Amputation can be performed for the treatment of the patient’s other health problems and fast and local controls of advanced malignant extremity tumors.

  14. Lower extremity amputations in diabetic Mexican American elders: incidence, prevalence and correlates.

    Science.gov (United States)

    Otiniano, Max E; Du, Xianglin; Ottenbacher, Kenneth; Black, Sandra A; Markides, Kyriakos S

    2003-01-01

    This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.

  15. Prosthetic options for below knee amputations after osteomyelitis and nonunion of the tibia.

    Science.gov (United States)

    Moshirfar, A; Showers, D; Logan, P; Esterhai, J L

    1999-03-01

    Below the knee amputation after trauma is an appropriate option for many patients with recalcitrant infection and nonunion of the tibia. Patients who have had transtibial amputations have lower energy expenditure, heart rate, and oxygen cost when ambulating with their prostheses than when using a three-point gait with crutches without their artificial limb. Innovative prosthetists have improved each of the five essential components of the limb amputated below the knee: socket, insert, shaft and pylon, foot and ankle assembly, and suspension system. Prosthetists are integral members of the patient's healthcare team. Their recommendations and direct patient care are essential to optimizing the functional ability of patients who have had amputations.

  16. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

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    Jandrić Slavica

    2002-01-01

    Full Text Available The results of below-knee amputations in 36 war wounded (mean age 35,42 were reviewed. The majority of the patients was wounded by land mines (94.4%. Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation in 30 (83.3% amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7% average 4.61 ± 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%. Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 ± 14.97 days for primary amputations, 32 ± 17.8 days for secondary amputations and 68.66 ± 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102. The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.

  17. Exploring ethical justification for self-demand amputation.

    Science.gov (United States)

    Tomasini, Floris

    2006-01-01

    Self-demand amputees are persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves. They want to rid themselves of a limb that they believe does not belong to their body-identity. The obsessive desire to have appendages surgically removed to fit an alternative body-image is medically and ethically controversial. My purpose in this paper is to provide a number of normative and professional ethical perspectives on whether or not it is possible to justify surgery for self-demand amputees. In doing so I proceed dialogically, moving between empirical context and normative theory, revealing the taken for granted normative assumptions (what I call the natural attitude--a technical term borrowed from phenomenology) that provide ethical limits to justifying the treatment of self-demand amputees. While I critically examine both Kantian responses against as well as Utilitarian responses for amputation on demand, I conclude that neither normative tradition can fully incorporate an understanding of what it is like to be a self-demand amputee. Since neither theory can justify the apparent non-rational desire of amputation on demand, ethical justification, I argue, falls short of the recognition that there may be a problem. To end, I introduce a meta-ethical idea, "the struggle for recognition," opening up the theoretical possibility of a hermeneutics of recognition before ethical justification that may be more sensitive to the problem of radical embodied difference exemplified by self-demand amputees. PMID:17115518

  18. Phalangeal regrowth in rodents: postamputational bone regrowth depends upon the level of amputation.

    Science.gov (United States)

    Neufeld, D A; Zhao, W

    1993-01-01

    Conflicting reports of distal phalangeal regrowth prompted a reexamination of bone growth following phalangeal amputation in mammals. Digits of neonatal and adult mice and rats were amputated at various levels. The short-term response was examined on histological sections, and long-term growth was documented by alizarin red-staining of KOH-digested digits. Three patterns of response were seen to correspond to three general levels of amputation. Complete bone regeneration occurred frequently by five weeks following amputation through the distal one-quarter of the distal phalanx. Amputation through the central region of the distal phalanx yielded substantial bone growth, but the form of the regrowth was imperfect even three months after amputation. Amputation through more proximal levels of the digit yielded no significant elongation. To investigate why the response varies in relation to the level of amputation, we are conducting both in vivo and in vitro experiments. We have learned that simple avulsion of the nail plate provokes substantial remodeling of the distal phalanx. We are further exploring the trophic influence of nail organ on bone structure and growth in vivo. We have also recently determined that entire digits may be kept alive in vitro when cultured in DMEM:F-12:BGJb medium supplemented with insulin, EGF and FGF. This system sufficiently replicates in vivo conditions such that osteogenesis occurs both endosteally and distal to the amputation plane in vitro. The effects of growth factors, retinoic acid, and the presence or absence of nail organ components on amputational bone growth at all three levels are currently being studied in vitro. The goal of these studies is to determine why bone fails to grow, undergoes hyperplasia, or regenerates following amputation at different levels in mammals. PMID:8302899

  19. Traumatic Amputation of Finger From an Alligator Snapping Turtle Bite.

    Science.gov (United States)

    Johnson, Robert D; Nielsen, Cynthia L

    2016-06-01

    Legend states that the alligator snapping turtle (Macrochelys temminckii) should be handled with extreme caution as it has jaw strength powerful enough to bite a wooden broomstick in half. Tales of bite injuries from what is the largest freshwater turtle in North America exist anecdotally, yet there are few descriptions of medical encounters for such. The risk of infection from reptilian bites to the hand in an aquatic environment warrants thorough antibiotic treatment in conjunction with hand surgery consultation. We present the first case report of a near total amputation of an index finger in an adolescent boy who had been bitten by a wild "gator snapper." PMID:27116923

  20. A case of psychosis who amputated his finger

    Directory of Open Access Journals (Sweden)

    Mehmet Cemal Kaya

    2013-03-01

    Full Text Available Self-harm behavior is defined as the person’s intentional,direct injuring of some body tissue or the whole body mostoften done without suicidal intentions. Mild types of selfmutilationis seen frequently however more severe onesare rarely seen. Severe self-mutilation is generally a signof a serious psychiatric disorder and it can result in organand/or organ functionality loss. In this study we aimed topresent a schizophrenic patient with repetitive self-mutilation.As a conclusion, practicing clinicians should takeinto consideration the possibility of self-harm behavior inschizophrenia patients especially if they have high riskproperties.Key words: Schizophrenia, self-mutilation, amputation

  1. Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature

    Directory of Open Access Journals (Sweden)

    Omer A. Raheem, MD

    2015-03-01

    Conclusion: We review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53.

  2. Sexuality in people with a lower limb amputation : a topic too hot to handle?

    NARCIS (Netherlands)

    Verschuren, J. E. A.; Enzlin, P.; Geertzen, J. H. B.; Dijkstra, P. U.; Dekker, R.

    2013-01-01

    Purpose: The purpose of this study was to analyze whether, and by whom sexuality is discussed in amputation departments. The focus was on whether professionals received questions about sexuality from their patients with a lower limb amputation and whether they addressed sexuality themselves, as well

  3. Peak Oxygen Consumption in Older Adults With a Lower Limb Amputation

    NARCIS (Netherlands)

    Wezenberg, Daphne; de Haan, Arnold; Faber, Willemijn X.; Slootman, Hans J.; van der Woude, Lucas H.; Houdijk, Han

    2012-01-01

    Objective: To investigate whether the aerobic capacity of older adults who underwent a lower limb amputation is associated with the presence, cause (traumatic or vascular), and level of amputation (transtibial or transfemoral). Design: Cross-sectional descriptive. Setting: Human motion laboratory at

  4. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review

    Directory of Open Access Journals (Sweden)

    Hemakumar Devan, MPhty

    2015-04-01

    Full Text Available Following amputation, people with transfemoral amputation (TFA and transtibial amputation (TTA adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1 amputated and intact leg and (2 amputated and referent leg of nondisabled controls were included (26 articles. Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.

  5. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review.

    Science.gov (United States)

    Devan, Hemakumar; Carman, Allan; Hendrick, Paul; Hale, Leigh; Ribeiro, Daniel Cury

    2015-01-01

    Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.

  6. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review.

    Science.gov (United States)

    Devan, Hemakumar; Carman, Allan; Hendrick, Paul; Hale, Leigh; Ribeiro, Daniel Cury

    2015-01-01

    Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking. PMID:26186283

  7. Rehabilitation after Amputation: Psychotherapeutic Intervention Module in Indian Scenario

    Directory of Open Access Journals (Sweden)

    Kalpana Srivastava

    2014-01-01

    Full Text Available Psychological aspects of adjustment to amputation are varied and not addressed in the present treatment regime. There is no research evidence available of psychological intervention and outcome in Indian scenario. One hundred and seventy-three consecutive patients with limb amputations were randomly assigned to psychotherapeutic intervention module (PIM, study group (n=90 and treatment as usual group (TAU, control group (n=83. Patients with psychotic disorder were excluded from the study. Carroll Rating Scale for Depression (CRSD, State-Trait Anxiety Inventory (STAI, Amputees Body Image Scale (ABIS, and Impact of Event Scale (IES along with specially designed information schedule were administered individually. Structured psychotherapeutic module was developed for the intervention. Patients in PIM group were given six therapy sessions, addressing the specific areas of concern. All patients were evaluated on the same tools after two months of therapy. Analysis showed that after treatment a significant reduction in scores was noted on CRSD, STAI, ABIS, and IES in the PIM group. On the TAU group a significant reduction was seen only in the ABIS. The psychological intervention module proposed by authors was efficacious in alleviating the psychological distress, depression, and anxiety and thus was vastly superior to the conventional method of management of amputees.

  8. Kinematic analysis of males with transtibial amputation carrying military loads

    Directory of Open Access Journals (Sweden)

    Barri L. Schnall, MPT

    2015-03-01

    Full Text Available The biomechanical responses to load carriage, a common task for dismounted troops, have been well studied in nondisabled individuals. However, with recent shifts in the rehabilitation and retention process of injured servicemembers, there remains a substantial need for understanding these responses in persons with lower-limb amputations. Temporal-spatial and kinematic gait parameters were analyzed among 10 male servicemembers with unilateral transtibial amputation (TTA and 10 uninjured male controls. Participants completed six treadmill walking trials in all combinations of two speeds (1.34 and 1.52 m/s and three loads (none, 21.8, and 32.7 kg. Persons with TTA exhibited biomechanical compensations to carried loads that are comparable to those observed in uninjured individuals. However, several distinct gait changes appear to be unique to those with TTA, notably, increased dorsiflexion (deformation of the prosthetic foot/ankle, less stance knee flexion on the prosthetic limb, and altered trunk forward lean/excursion. Such evidence supports the need for future work to assess the risk for overuse injuries with carried loads in this population in addition to guiding the development of adaptive prosthetic feet/components to meet the needs of redeployed servicemembers or veterans/civilians in physically demanding occupations.

  9. Surgical reimplantation of penile glans amputation in children during circumcision

    Directory of Open Access Journals (Sweden)

    Bouassida Khaireddine

    2014-01-01

    Full Text Available Circumcision is one of the oldest and most commonly performed surgical procedures. Unfortunately, various complications may occur during circumcision, ranging from trivial to tragic such as penile amputation which is a serious complication and a challenging injury to treat. We describe two cases of non-microsurgical successful reattachment of a distal penile glans which were amputated during circumcision. In the first case, a 5-year-old child underwent circumcision by an urologist under local anesthesia. In the second one, a 3-year-old child underwent circumcision by a general practitioner who used to make circumcision. In this article, the literature is reviewed; results and potential complications of this surgery are also discussed. Glans sensation was present, early morning erection was maintained, and there was an erectile response during penile manipulation in both cases. Although circumcision is not technically difficult, it should be taken seriously. The use of microsurgical reattachment is not always possible, especially in pediatric cases; it also requires special equipment and training.

  10. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Swaminathan A

    2014-07-01

    Full Text Available Aparna Swaminathan,1 Sreekanth Vemulapalli,1,2 Manesh R Patel,1,2 W Schuyler Jones1,2 1Department of Medicine, Duke University Medical Center, Durham, NC, USA; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE amputation (LEA, although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. Keywords: peripheral artery disease, lower extremity amputation, mortality

  11. Early interfaced neural activity from chronic amputated nerves

    Directory of Open Access Journals (Sweden)

    Kshitija Garde

    2009-05-01

    Full Text Available Direct interfacing of transected peripheral nerves with advanced robotic prosthetic devices has been proposed as a strategy for achieving natural motor control and sensory perception of such bionic substitutes, thus fully functionally replacing missing limbs in amputees. Multi-electrode arrays placed in the brain and peripheral nerves have been used successfully to convey neural control of prosthetic devices to the user. However, reactive gliosis, micro hemorrhages, axonopathy and excessive inflammation, currently limit their long-term use. Here we demonstrate that enticement of peripheral nerve regeneration through a non-obstructive multi-electrode array, after either acute or chronic nerve amputation, offers a viable alternative to obtain early neural recordings and to enhance long-term interfacing of nerve activity. Non restrictive electrode arrays placed in the path of regenerating nerve fibers allowed the recording of action potentials as early as 8 days post-implantation with high signal-to-noise ratio, as long as 3 months in some animals, and with minimal inflammation at the nerve tissue-metal electrode interface. Our findings suggest that regenerative on-dependent multi-electrode arrays of open design allow the early and stable interfacing of neural activity from amputated peripheral nerves and might contribute towards conveying full neural control and sensory feedback to users of robotic prosthetic devices. .

  12. Reduced Incidence of Foot-Related Hospitalisation and Amputation amongst Persons with Diabetes in Queensland, Australia.

    Directory of Open Access Journals (Sweden)

    Peter A Lazzarini

    Full Text Available To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management.All data from cases admitted for the principal reason of diabetes foot-related hospitalisation or amputation in Queensland from 2005-2010 were obtained from the Queensland Hospital Admitted Patient Data Collection dataset. Incidence rates for foot-related hospitalisation (admissions, bed days used and amputation (total, minor, major cases amongst persons with diabetes were calculated per 1,000 person-years with diabetes (diabetes population and per 100,000 person-years (general population. Age-sex standardised incidence and age-sex adjusted Poisson regression models were also calculated for the general population.There were 4,443 amputations, 24,917 hospital admissions and 260,085 bed days used for diabetes foot-related complications in Queensland. Incidence per 1,000 person-years with diabetes decreased from 2005 to 2010: 43.0% for hospital admissions (36.6 to 20.9, 40.1% bed days (391 to 234, 40.0% total amputations (6.47 to 3.88, 45.0% major amputations (2.18 to 1.20, 37.5% minor amputations (4.29 to 2.68 (p < 0.01 respectively. Age-sex standardised incidence per 100,000 person-years in the general population also decreased from 2005 to 2010: 23.3% hospital admissions (105.1 to 80.6, 19.5% bed days (1,122 to 903, 19.3% total amputations (18.57 to 14.99, 26.4% major amputations (6.26 to 4.61, 15.7% minor amputations (12.32 to 10.38 (p < 0.01 respectively. The age-sex adjusted incidence rates per calendar year decreased in the general population (rate ratio (95% CI; hospital admissions 0.949 (0.942-0.956, bed days 0.964 (0.962-0.966, total amputations 0.962 (0.946-0.979, major amputations 0.945 (0.917-0.974, minor amputations 0.970 (0.950-0.991 (p < 0.05 respectively.There were significant

  13. Reconstruction of an Amputated Glans Penis With a Buccal Mucosal Graft: Case Report of a Novel Technique

    OpenAIRE

    Aboutaleb, Hamdy

    2014-01-01

    Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Peni...

  14. Fungal communities in soil beneath Scots pine and their stumps. Effect of fungi on Heterobasidion annosum and Armillaria ostoyae growth

    Directory of Open Access Journals (Sweden)

    Hanna Kwaśna

    2014-08-01

    Full Text Available The soil beneath 30-year-old Scots pines, was inhabited by fungi communities which were at least iwicc as big as communities from ihe 49-year-old stand. The fungi communities in soil beneath the stumps were much smaller compared to those beneath the live trees and more abundant in the 30- than in the 49--year-old stand. The fungal communities in soil beneath the 30-year-old pines have bigger antagonistic effect on Heterobasidion annosum and Armillaria ostoyae than those beneath the 49-year-old stand. The decrease in density of fungi and in the frequency of species antagonistic to H. annosum and A. ostoyae resulted in the decrease of the antagonistic effect on both pathogens in soil beneath pine stumps.

  15. Cardiovascular disease risk factors in combat veterans after traumatic leg amputations.

    Science.gov (United States)

    Rose, H G; Schweitzer, P; Charoenkul, V; Schwartz, E

    1987-01-01

    Traumatic leg amputation, but not arm amputation, in World War II combat veterans has been associated with subsequent increased ischemic heart disease mortality. In a pilot project we examined a group of 19 high-risk Vietnam War veterans with bilateral above-knee amputations in comparison with a control group with unilateral below-elbow amputations. Nine of the 19 above-knee amputees were hypertensive (p = 0.05) and obese by hydrostatic weighing (p less than 0.001). Obesity was strongly associated with hypertension, decreased glucose tolerance, and marked hyperinsulinemia. Cigarette smoking, blood lipid abnormalities, and decreased cardiovascular fitness were not implicated as significant risk factors. Long-term risks of amputation may be related to metabolic and hemodynamic sequelae of excessive maturity-onset weight gain in young men immobilized by loss of lower limbs.

  16. Finite element analysis of the contact interface between trans-femoral stump and prosthetic socket.

    Science.gov (United States)

    Zhang, Linlin; Zhu, Ming; Shen, Ling; Zheng, Feng

    2013-01-01

    Transfemoral amputees need prosthetic devices after amputation surgery, and the interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee's satisfaction and comfort. The purpose of this study was to build a nonlinear finite element model to investigate the interface pressure between the above-knee residual limb and its prosthetic socket. The model was three-dimensional (3D) with consideration of nonlinear boundary conditions. Contact analysis was used to simulate the friction conditions between skin and the socket. The normal stresses up to 80.57 kPa at the distal end of the soft tissue. The longitudinal and circumferential shear stress distributions at the limb-socket interface were also simulated. This study explores the influences of load transfer between trans-femoral residual limb and its prosthetic socket.

  17. Effect of photoperiod on characteristics of semen obtained by electroejaculation in stump-tailed macaques (Macaca arctoides).

    Science.gov (United States)

    García Granados, Mónica Dafne; Hernández López, Leonor Estela; Córdoba Aguilar, Alejandro; Cerda Molina, Ana Lilia; Pérez-Ramírez, Olivia; Mondragón-Ceballos, Ricardo

    2014-07-01

    Some environmental variables determining seasonal reproduction in mammals are temperature, humidity, food availability, and photoperiod. Among these, photoperiod is considered the main regulator of primates' seasonal reproduction, thus the latitudinal distribution of primate populations is a key factor determining the appearance of seasonal reproduction. The present work presents supporting discrete seasonality in male stump-tailed macaques (Macaca arctoides). We investigated whether semen quality and testosterone covaried with Mexico City's photoperiod and relative humidity by analyzing variations in the portions that form the ejaculate: the seminal liquid, the seminal coagulum, and the copulatory plug. Five male adult stump-tailed macaques were electroejaculated once a month, obtaining three semen samples per male, from August 2011 to July 2012 (except for December 2011) (n = 165). Our results showed that stump-tailed macaque sperm counts were significantly different between the portions of the ejaculate. The seminal coagulum contained the significantly largest number of spermatozoids, followed by the copulatory plug and the seminal fluid. Photoperiod and relative humidity had major influence on the sperm count in the seminal coagulum and the testosterone concentrations. Testosterone reached its highest values around the time when days and nights lasted the same hours, decreasing when days either grew longer or became shorter. Concerning relative humidity, sperm counts in the seminal coagulum were highly variable on dry days, but decreased as the relative humidity increased. We conclude that stump-tailed macaques have a discrete seasonality, occurring in spring and fall when macaques' reproductive condition and readiness for postcopulatory intrasexual competition increase. PMID:24585247

  18. Relation between Rice Crop Quality (Protein Content) and Fertilizer Amount as Well as Rice Stump Density Derived from Helicopter Data

    OpenAIRE

    Kohei Arai; Masanoori Sakashita; Osamu Shigetomi; Yuko Miura

    2015-01-01

    Relation between protein content in rice crops and fertilizer amount as well as rice stump density is clarified with a multi-spectral camera data mounted on a radio-wave controlled helicopter. Estimation of protein content in rice crop and total nitrogen content in rice leaves through regression analysis with Normalized Difference Vegetation Index: NDVI derived from camera mounted radio-controlled helicopter is already proposed. Through experiments at rice paddy fields which is situated at Sa...

  19. Short-term effects of thinning, clear-cutting and stump harvesting on methane exchange in a boreal forest

    Directory of Open Access Journals (Sweden)

    E. Sundqvist

    2014-03-01

    Full Text Available Forest management practices can alter soil conditions, affecting the consumption and production processes that control soil methane (CH4 exchange. We studied the short-term effects of thinning, clear-cutting and stump harvesting on the CH4 exchange between soil and atmosphere at a boreal forest site in central Sweden, using an undisturbed plot as the control. Chambers in combination with a high precision laser gas analyser were used for continuous measurements. Both the undisturbed plot and the thinned plot were net sinks of CH4, whereas the clear-cut plot and the stump harvested plot were net CH4 sources. The CH4 uptake at the thinned plot was reduced in comparison to the undisturbed plot. The shift from sink to source at the clear-cut and stump harvested plots was probably due to a rise of the water table and an increase in soil moisture, leading to lower gas diffusivity and more reduced conditions which favour CH4 production by archea. Reduced evapotranspiration after harvesting leads to wetter soils, decreased CH4 consumption and increased CH4 production, and should be accounted for in the CH4 budget of managed forests.

  20. Estimating forest crown area removed by selection cutting: a linked regression-GIS approach based on stump diameters

    Science.gov (United States)

    Anderson, S.C.; Kupfer, J.A.; Wilson, R.R.; Cooper, R.J.

    2000-01-01

    The purpose of this research was to develop a model that could be used to provide a spatial representation of uneven-aged silvicultural treatments on forest crown area. We began by developing species-specific linear regression equations relating tree DBH to crown area for eight bottomland tree species at White River National Wildlife Refuge, Arkansas, USA. The relationships were highly significant for all species, with coefficients of determination (r(2)) ranging from 0.37 for Ulmus crassifolia to nearly 0.80 for Quercus nuttalliii and Taxodium distichum. We next located and measured the diameters of more than 4000 stumps from a single tree-group selection timber harvest. Stump locations were recorded with respect to an established gl id point system and entered into a Geographic Information System (ARC/INFO). The area occupied by the crown of each logged individual was then estimated by using the stump dimensions (adjusted to DBHs) and the regression equations relating tree DBH to crown area. Our model projected that the selection cuts removed roughly 300 m(2) of basal area from the logged sites resulting in the loss of approximate to 55 000 m(2) of crown area. The model developed in this research represents a tool that can be used in conjunction with remote sensing applications to assist in forest inventory and management, as well as to estimate the impacts of selective timber harvest on wildlife.

  1. The capability of fiber Bragg grating sensors to measure amputees' trans-tibial stump/socket interface pressures.

    Science.gov (United States)

    Al-Fakih, Ebrahim A; Osman, Noor Azuan Abu; Eshraghi, Arezoo; Adikan, Faisal Rafiq Mahamd

    2013-08-12

    This study presents the first investigation into the capability of fiber Bragg grating (FBG) sensors to measure interface pressure between the stump and the prosthetic sockets of a trans-tibial amputee. FBG element(s) were recoated with and embedded in a thin layer of epoxy material to form a sensing pad, which was in turn embedded in a silicone polymer material to form a pressure sensor. The sensor was tested in real time by inserting a heavy-duty balloon into the socket and inflating it by using an air compressor. This test was conducted to examine the sensitivity and repeatability of the sensor when subjected to pressure from the stump of the trans-tibial amputee and to mimic the actual environment of the amputee's Patellar Tendon (PT) bar. The sensor exhibited a sensitivity of 127 pm/N and a maximum FSO hysteresis of around ~0.09 in real-time operation. Very good reliability was achieved when the sensor was utilized for in situ measurements. This study may lead to smart FBG-based amputee stump/socket structures for pressure monitoring in amputee socket systems, which will result in better-designed prosthetic sockets that ensure improved patient satisfaction.

  2. The Capability of Fiber Bragg Grating Sensors to Measure Amputees’ Trans-Tibial Stump/Socket Interface Pressures

    Directory of Open Access Journals (Sweden)

    Faisal Rafiq Mahamd Adikan

    2013-08-01

    Full Text Available This study presents the first investigation into the capability of fiber Bragg grating (FBG sensors to measure interface pressure between the stump and the prosthetic sockets of a trans-tibial amputee. FBG element(s were recoated with and embedded in a thin layer of epoxy material to form a sensing pad, which was in turn embedded in a silicone polymer material to form a pressure sensor. The sensor was tested in real time by inserting a heavy-duty balloon into the socket and inflating it by using an air compressor. This test was conducted to examine the sensitivity and repeatability of the sensor when subjected to pressure from the stump of the trans-tibial amputee and to mimic the actual environment of the amputee’s Patellar Tendon (PT bar. The sensor exhibited a sensitivity of 127 pm/N and a maximum FSO hysteresis of around ~0.09 in real-time operation. Very good reliability was achieved when the sensor was utilized for in situ measurements. This study may lead to smart FBG-based amputee stump/socket structures for pressure monitoring in amputee socket systems, which will result in better-designed prosthetic sockets that ensure improved patient satisfaction.

  3. Bioimpedance system for monitoring muscle and cardiovascular activity in the stump of lower-limb amputees

    International Nuclear Information System (INIS)

    A bioimpedance system for the continuous measurement of non-invasive physiological parameters in lower-limb amputees is presented. The aim of the system is to monitor as many physiological parameters as possible from a single bioimpedance electrode configuration. In this way, a simple, low-cost and low-size autonomous system is developed that is able to continuously monitor the amputee in different environments (home, work, etc). The system measures both electrical impedance myography and electrical impedance plethysmography in the stump with electrodes placed in the inside face of a silicone interface. Such a system allows for the monitoring of a patient's muscle activity, and heart and breath rate, thus enabling the study and continuous monitoring of prosthesis adaptation and improvement of patient's gait to reduce physiological stress. Additionally, it can prevent cardiovascular problems due to the effort involved in the use of prostheses, which can decrease the life expectancy of amputees with previous vascular diseases. Experimental results obtained from different amputees' test validate the purpose of the system. (paper)

  4. Mediolateral angular momentum changes in persons with amputation during perturbed walking.

    Science.gov (United States)

    Sheehan, Riley C; Beltran, Eduardo J; Dingwell, Jonathan B; Wilken, Jason M

    2015-03-01

    Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk. This study determined how lateral walking surface perturbations affected the regulation of whole body and individual leg angular momentum in able-bodied controls and individuals with unilateral transtibial amputation. Participants walked at fixed speed in a Computer Assisted Rehabilitation Environment with no perturbations and continuous, pseudo-random, mediolateral platform oscillations. Both the ranges and variability of angular momentum for both the whole body and both legs were significantly greater (pangular momentum range or variability during unperturbed walking. The range of frontal plane angular momentum was significantly greater for those with amputation than for controls for all segments (pangular momentum ranges were greater for patients with amputation. However, for the prosthetic leg, angular momentum ranges were less for patients than controls. Patients with amputation were significantly more affected by the perturbations. Though patients with amputation were able to maintain similar patterns of whole body angular momentum during unperturbed walking, they were more highly destabilized by the walking surface perturbations. Individuals with transtibial amputation appear to predominantly use altered motion of the intact limb to maintain mediolateral stability.

  5. Patterns of extremity traumas leading to amputation in lran:results of Iranian National Trauma Project

    Institute of Scientific and Technical Information of China (English)

    Majid Moini; Mohammad R Rasouli; Ali Khaji; Farshad Farshidfar; Pedram Heidari

    2009-01-01

    Obiective: To determine the patterns of traumatic extremity injuries leading to amputation in Iran.Methotis: Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation.This project was conducted in 8 major cities during 2000-2004.Results: of 17 753 traumatic Patients,164 (0.92%) had injuries to the extremities that resulted in the limb amputation.Of these,143 (87.2%) were men.The patient's mean age was 29.0 years±15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%).One hundred and four cases were occupational accidents (63.4%).Blunt trauma was in 54.9% of the cases.The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%).Amputation of hand fingers was the most frequent type of amputation (125 cases,76.2%).One patient died from severe associated injuries.Conclusions: This study shows the patterns of traumatic limb amputation in Iran,a developing country.Resuits of this study may be used in preventive strategic planning.

  6. Quality of Life among Egyptian Patients with Upper and Lower Limb Amputation: Sex Differences

    Directory of Open Access Journals (Sweden)

    Salwa A. Mohammed

    2014-01-01

    Full Text Available Background. Limb amputation is a life-changing event that can cause significant disruptions in many important areas of existence. Aim of this study. To evaluate the quality of life (QOL of patients with limb amputation and identify the factors affecting the quality of life of patients with limb amputation among Egyptian patients. Research Design. It was a descriptive exploratory design. Setting. The study was conducted in Orthopedics and Surgical Department in Emergency Hospital at Mansoura University Hospitals. Sample. A sample of convenience of 100 adult male and female patients who met the inclusion criteria was included. Tools. (a Structured interview questionnaire (SIQ was used to collect personal data, (b short form (36 health status questionnaires: this part was utilized to assess the quality of life among Egyptian patients with amputation. Results. The result of this study indicates that most participants experienced a change in the quality of life. There is a statistically significant difference between total QOL aspects and each of the following: age, gender, educational level, and type of work. Conclusion. Limb amputation tends to cause increased disability for those amputated patients. The age, gender, place of amputation, and marital status are found as statistically significant factors with physical component and psychological component.

  7. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey.

    Science.gov (United States)

    Furtado, S; Grimer, R J; Cool, P; Murray, S A; Briggs, T; Fulton, J; Grant, K; Gerrand, C H

    2015-09-01

    Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs.

  8. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey.

    Science.gov (United States)

    Furtado, S; Grimer, R J; Cool, P; Murray, S A; Briggs, T; Fulton, J; Grant, K; Gerrand, C H

    2015-09-01

    Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs. PMID:26330598

  9. Assessment of anxiety and depression after lower limb amputation in Jordanian patients

    Directory of Open Access Journals (Sweden)

    Ziad M Hawamdeh

    2008-06-01

    Full Text Available Ziad M Hawamdeh1, Yasmin S Othman2, Alaa I Ibrahim31Department of Physical Therapy, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan; 2Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan; 3Lecturer, Department of Physical Therapy for Pediatrics and Pediatric surgery, Faculty of Physical Therapy, Cairo University, Giza, EgyptObjective: This study aimed to assess the prevalence of anxiety and depression among Jordanian lower limb amputees with different clinical characteristics and sociodemographic data (gender, marital status, social support, income, type and level of amputation, and occupation.Methods: Participants were 56 patients with unilateral lower limb amputation with mean duration (8.4 ± 5.75 years. They were recruited from inpatient and outpatient clinics of Jordan University hospital, Royal Farah Rehabilitation Center, and Al-basheer hospital in Amman, Jordan. Participants responded to a questionnaire that included a battery of questions requesting brief information about sociodemographic variables and characteristics of amputation. The level of depression and anxiety in each participating patient was assessed by the Hospital Anxiety and Depression Scale (HADS.Results: The prevalence of anxiety and depressive symptoms were 37% and 20%, respectively. Factors associated with high prevalence of psychological symptoms included female gender, lack of social support, unemployment, traumatic amputation, shorter time since amputation, and amputation below the knee. These findings were confirmed by a significant reduction of anxiety and depression scores in patients who received social support, patients with amputation due to disease, and patients with amputation above the knee. Presence of pain and use of prosthesis had no effect on the prevalence.Conclusions: The findings of the present study highlight the high incidence of psychiatric disability and

  10. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.

    Science.gov (United States)

    Iosa, Marco; Paradisi, Francesco; Brunelli, Stefano; Delussu, Anna Sofia; Pellegrini, Roberto; Zenardi, Daniele; Paolucci, Stefano; Traballesi, Marco

    2014-01-01

    Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.

  11. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.

    Science.gov (United States)

    Iosa, Marco; Paradisi, Francesco; Brunelli, Stefano; Delussu, Anna Sofia; Pellegrini, Roberto; Zenardi, Daniele; Paolucci, Stefano; Traballesi, Marco

    2014-01-01

    Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used. PMID:25144175

  12. A functional and psychosocial assessment of patients with post-Sudeck atrophy amputation.

    Science.gov (United States)

    Szeinberg-Arazi, D; Heim, M; Nadvorna, H; Ner, I Z; Szeinberg, A; Azaria, M

    1993-04-01

    Twelve patients with reflex sympathetic dystrophy were referred to a comprehensive orthopaedic rehabilitation center after failure of conservative management. Ten underwent amputation of the affected limb and, although functional improvement occurred in the patients undergoing lower limb amputation, psychosocial dysfunction persisted. All the patients required psychological support. In cases of post-Sudeck amputation, early orthopaedic diagnosis and referral to a comprehensive treatment center are recommended. In the 12 cases described here, apart from the obvious limb pathology, severe psychological inadequacies were found to be present. PMID:7682058

  13. [Self-amputation of the penis treated immediately: Case report and review of the literature].

    Science.gov (United States)

    Odzébé, A W S; Bouya, P A; Otiobanda, G F; Banga Mouss, R; Nzaka Moukala, C; Ondongo Atipo, A M; Ondziel Opara, A S

    2015-12-01

    Self-amputation of the penis treated immediately: case report and review of the literature. Self-amputation of the penis is rare in urological practice. It occurs more often in a context psychotic disease. It can also be secondary to alcohol or drugs abuse. Treatment and care vary according on the severity of the injury, the delay of consultation and the patient's mental state. The authors report a case of self-amputation of the penis in an alcoholic context. The authors analyze the etiological and urological aspects of this trauma.

  14. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

    DEFF Research Database (Denmark)

    Pickwell, Kirsty; Siersma, Volkert; Kars, Marleen;

    2015-01-01

    OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation...... of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries...... the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score...

  15. Revisiting risks associated with mortality following initial transtibial or transfemoral amputation

    OpenAIRE

    Barbara E. Bates, MD; Dawei Xie, PhD; Jibby E. Kurichi, MPH; Diane Cowper Ripley, PhD; Pui L. Kwong, MPH; Margaret G. Stineman, MD

    2013-01-01

    This study’s objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputa...

  16. Bilateral upper limb amputations in victims of high tension electrical injuries: Three case studies

    Directory of Open Access Journals (Sweden)

    Cajetan Nwadinigwe

    2015-02-01

    Full Text Available Bilateral upper limb amputations result in severe disability. High voltage electrical injury is a rare cause of such an outcome and injuries often occur as occupational hazards. We present three case reports of accidental high voltage injuries that occurred in a non-occupational setting. Victims were all initially managed at other centres before referral to our hospital and all subsequently had bilateral upper limb amputations. The high cost of treatment, importance of prevention, and need for rehabilitation are highlighted.

  17. Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

    OpenAIRE

    Sehirlioglu, Ali; Ozturk, Cagatay; Yazicioglu, Kamil; Tugcu, Ilknur; Yilmaz, Bilge; Goktepe, Ahmet Salim

    2007-01-01

    This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time ...

  18. Quality of Life Following Amputation or Limb Preservation in Patients with Lower Extremity Bone Sarcoma

    OpenAIRE

    Gary E Mason; Lele eAung; Sarah eGall; Meyers, Paul A; Robert eButler; Sarah eKrug; Mimi eKim; Healey, John H.; Richard eGorlick

    2013-01-01

    PURPOSE: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The aim of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb preservation procedure. PATIENTS AND METHODS: Eighty-two lon...

  19. Quality of Life Following Amputation or Limb Preservation in Patients with Lower Extremity Bone Sarcoma

    Directory of Open Access Journals (Sweden)

    Gary E Mason

    2013-08-01

    Full Text Available PURPOSE: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The aim of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb preservation procedure. PATIENTS AND METHODS: Eighty-two long-term survivors of lower extremity bone sarcoma were studied to make a comparison of the overall quality of life, pain assessment and psychological evaluations in limb preservation and amputation patients. Forty-eight patients with limb preservation and thirty-four patients with amputations were enrolled in the study. Validated psychometric measures including the Quality of Life Questionnaire, the Minnesota Multiphasic Personality Inventory and visual analog scales were utilized.RESULTS: The overall quality of life of patients with limb preservation was significantly higher than patients with amputation (p-value < 0.01. Significant differences were noted in the categories of material well being, job satisfiers and occupational relations. CONCLUSION: The overall quality of life of patients with limb preservation appears to be better than for those patients with amputation based on the quality of life questionnaire in patients surviving lower extremity bone sarcoma. Further analysis needs to verify the results and focus on the categories that significantly affect the overall quality of life.

  20. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

    Science.gov (United States)

    Jiang, Guangyao; Yin, Xuntao; Li, Chuanming; Li, Lei; Zhao, Lu; Evans, Alan C.; Jiang, Tianzi; Wu, Jixiang; Wang, Jian

    2015-01-01

    Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA) of white matter (WM) were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC). Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections. PMID:26587289

  1. Metabolic and body composition changes in first year following traumatic amputation

    Directory of Open Access Journals (Sweden)

    Carly S. Eckard, MS, RD

    2015-09-01

    Full Text Available Body composition and metabolism may change considerably after traumatic amputation because of muscle atrophy and an increase in adiposity. The purpose of this study was to quantify changes in weight, body composition, and metabolic rate during the first year following traumatic amputation in military servicemembers. Servicemembers without amputation were included for comparison. Participants were measured within the first 12 wk after amputation (baseline and at 6, 9, and 12 mo after amputation. Muscle mass, fat mass, weight, and metabolic rate were measured at each time point. There was a significant increase in weight and body mass index in the unilateral group between baseline and all follow-up visits (p < 0.01. Over the 12 mo period, total fat mass and trunk fat mass increased in both unilateral and bilateral groups; however, these changes were not statistically significant over time. Muscle mass increased in both the unilateral and bilateral groups despite percent of lean mass decreasing. No changes in resting metabolism or walking energy expenditure were observed in any group. The results of this study conclude that weight significantly increased because of an increase in both fat mass and muscle mass in the first year following unilateral and bilateral amputation.

  2. Does unilateral transtibial amputation lead to greater metabolic demand during walking?

    Directory of Open Access Journals (Sweden)

    Elizabeth Russell Esposito, PhD

    2015-01-01

    Full Text Available Previous literature reports greater metabolic demand of walking following transtibial amputation. However, most research focuses on relatively older, less active, and often dysvascular amputees. Servicemembers with traumatic amputation are typically young, fit, and highly active before and often following surgical amputation of their lower limb. This study compared the metabolic demand of walking in young, active individuals with traumatic unilateral transtibial amputation (TTA and nondisabled controls. Heart rate (HR, rate of oxygen consumption, and rating of perceived exertion (RPE were calculated as subjects walked at a self-selected velocity and at five standardized velocities based on leg length. The TTA group completed a Prosthetics Evaluation Questionnaire. Oxygen consumption (p = 0.89, net oxygen consumption (p = 0.32, and RPE (p = 0.14 did not differ between groups. Compared with controls, HR was greater in the TTA group and increased to a greater extent with velocity (p < 0.001. Overall, the TTA group rated their walking abilities as high (mean: 93% out of 100%. This is the first study to report equivalent metabolic demand between persons with amputation and controls walking at the same velocity. These results may reflect the physical fitness of the young servicemembers with traumatic amputations and may serve to guide outcome expectations in the future.

  3. Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

    Directory of Open Access Journals (Sweden)

    Colby Hansen, MD

    2015-04-01

    Full Text Available To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

  4. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    Guangyao Jiang

    2015-01-01

    Full Text Available Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA of white matter (WM were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC. Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections.

  5. Persons with unilateral transfemoral amputation have altered lumbosacral kinetics during sitting and standing movements.

    Science.gov (United States)

    Hendershot, Brad D; Wolf, Erik J

    2015-07-01

    Increases in spinal loading have been related to altered movements of the lower back during gait among persons with lower limb amputation, movements which are self-perceived by these individuals as contributing factors in the development of low back pain. However, the relationships between altered trunk kinematics and associated changes in lumbosacral kinetics during sit-to-stand and stand-to-sit movements in this population have not yet been assessed. Three-dimensional lumbosacral kinetics (joint moments and powers) were compared between 9 persons with unilateral transfemoral amputation (wearing both a powered and passive knee device), and 9 uninjured controls, performing five consecutive sit-to-stand and stand-to-sit movements. During sit-to-stand movements, lumbosacral joint moments and powers were significantly larger among persons with transfemoral amputation relative to uninjured controls. During stand-to-sit movements, lumbosacral joint moments and powers were also significantly larger among persons with transfemoral amputation relative to uninjured controls, with the exception of sagittal joint powers. Minimal differences in kinetic measures were noted between the powered and passive knee devices among persons with transfemoral amputation across all conditions. Altered lumbosacral kinetics during sitting and standing movements, important activities of daily living, may play a biomechanical role in the onset and/or recurrence of low back pain or injury among persons with lower-limb amputation.

  6. Persons with unilateral transfemoral amputation have altered lumbosacral kinetics during sitting and standing movements.

    Science.gov (United States)

    Hendershot, Brad D; Wolf, Erik J

    2015-07-01

    Increases in spinal loading have been related to altered movements of the lower back during gait among persons with lower limb amputation, movements which are self-perceived by these individuals as contributing factors in the development of low back pain. However, the relationships between altered trunk kinematics and associated changes in lumbosacral kinetics during sit-to-stand and stand-to-sit movements in this population have not yet been assessed. Three-dimensional lumbosacral kinetics (joint moments and powers) were compared between 9 persons with unilateral transfemoral amputation (wearing both a powered and passive knee device), and 9 uninjured controls, performing five consecutive sit-to-stand and stand-to-sit movements. During sit-to-stand movements, lumbosacral joint moments and powers were significantly larger among persons with transfemoral amputation relative to uninjured controls. During stand-to-sit movements, lumbosacral joint moments and powers were also significantly larger among persons with transfemoral amputation relative to uninjured controls, with the exception of sagittal joint powers. Minimal differences in kinetic measures were noted between the powered and passive knee devices among persons with transfemoral amputation across all conditions. Altered lumbosacral kinetics during sitting and standing movements, important activities of daily living, may play a biomechanical role in the onset and/or recurrence of low back pain or injury among persons with lower-limb amputation. PMID:26050872

  7. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Science.gov (United States)

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  8. Stump-harvest in Sweden : from an environmental impact assessment study to recommendations and an adaptive forest management approach from the Swedish Forest Agency

    Energy Technology Data Exchange (ETDEWEB)

    Egnell, G. [Swedish Univ. of Agricultural Sciences, Umea (Sweden). Faculty of Forestry, Dept. of Forest Ecology and Management

    2010-07-01

    Sweden is increasingly relying on the production of energy from its forest stocks, and its domestic annual bioenergy market is expanding rapidly. An environmental impact assessment study was conducted to determine the loss of biodiversity through the loss of coarse woody debris; soil damage; methyl mercury releases in surface waters; fine material and organic matter on surface waters; the greenhouse gas (GHG) balance; aesthetics; and side and stand productivity. The aim of the study was to determine the potential impact of tree stump harvesting in Swedish forests. The study showed that moderate stump-harvesting of between 5 and 10 per cent of the annual final cut areas will not have a significant impact on suitable stands. Results of the study will be used to provide recommendations for stand level restrictions where stump-harvesting is practiced.

  9. Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy

    Directory of Open Access Journals (Sweden)

    Konstantinos Blouhos

    2013-01-01

    Full Text Available When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula.

  10. Exploring the Use of Non-Image-Based Ultrasound to Detect the Position of the Residual Femur within a Stump

    Science.gov (United States)

    Chong, Sook-Yee; Röhrle, Oliver

    2016-01-01

    A satisfactorily fitted socket interacts dynamically with the stump in order to support body weight, transmit load effectively, enhance dynamic stability, and enable the control and stabilization of the residual limb. The internal dynamics occurring within a socket is important in determining optimal fit. Many measurement and imaging techniques, such as X-rays, have been utilized to investigate the movement of the residual femur within the stump during gait. However, due to associated health risks and costs, none of the current techniques have been extended to clinical prosthetics. The use of B-mode ultrasound has been suggested as a safe and cheap alternative, and has been utilized in previous studies to monitor the motion of the femur. However, the need to create a duplicate socket and time-consuming analysis of the images were obstacles to the system being applied clinically. This study aims to gauge the effectiveness of a non-image based ultrasound system. Here, we determined errors expected from the measurements. Accuracy errors of 2.9 mm to 8.4 mm and reproducibility measurements within a standard deviation of 3.9 mm are reported. We also estimated errors up to 14.4 mm in in-vivo measurements. We think there is potential in developing this technique, and we hope to reduce some technical difficulties such that it can, one day, be easily incorporated into prosthetic fitting. PMID:27764120

  11. Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump.METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis,operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined.RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology,use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma.The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear.CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

  12. Comparison and Efficacy of LigaSure and Rubber Band Ligature in Closing the Inflamed Cecal Stump in a Rat Model of Acute Appendicitis

    OpenAIRE

    Chun-Chieh Yeh; Chia-Ing Jan; Horng-Ren Yang; Po-Han Huang; Long-Bin Jeng; Wen-Pang Su; Hui-Chen Chen

    2015-01-01

    Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, th...

  13. A possible variant of Bouveret's syndrome presenting as a duodenal stump obstruction by a gallstone after Roux-en-Y gastrectomy: a case report

    Directory of Open Access Journals (Sweden)

    Mittal Shruti

    2009-05-01

    Full Text Available Abstract Introduction Bouveret's syndrome is characterized by gastric outlet obstruction due to a gallstone in the duodenum, usually in association with a cholecystoduodenal fistula. Case presentation We report the case of a 69-year-old Caucasian man who developed duodenal stump obstruction due to an impacted gallstone after having previously undergone Roux-en-Y gastrectomy. Conclusions Duodenal stump obstruction after Roux-en-Y gastrectomy is rare, and may be difficult to manage. Patients who present with upper gastrointestinal or pancreatobiliary pathology after previous gastric surgery should be managed in centres with the availability of appropriate endoscopic and surgical experience.

  14. Influence of Hallux Rigidus on Reamputation in Patients With Diabetes Mellitus After Partial Hallux Amputation.

    Science.gov (United States)

    Oliver, Noah G; Attinger, Christopher E; Steinberg, John S; Evans, Karen K; Vieweger, David; Kim, Paul J

    2015-01-01

    Diabetic foot ulceration of the plantar hallux is a challenging condition and can require partial hallux amputation when complicated by infection. Lower extremity biomechanics play an important role in the development of hallux ulcers, and hallux rigidus (HR) could influence the outcomes after partial hallux amputation. We hypothesized that radiographic evidence of HR in patients with diabetes would be associated with greater ulcer recurrence and reamputation rates after partial hallux amputation. We performed a retrospective review of all patients with diabetes who had undergone a partial hallux amputation from January 2005 to December 2012. The subjects were divided into 2 cohorts according to the presence or absence of HR identified on preoperative radiographs. Baseline characteristics and outcomes were compared using a 2-sample Student's t test for continuous variables, and categorical variables were compared using the chi-square test for homogeneity and Fisher's exact test. A total of 52 patients were included, with 16 (31%) positive for radiographic evidence of HR at partial hallux amputation. Differences in the patient demographics and comorbidities were not significant between 2 cohorts with and without HR or reamputation. Reamputation was required in 5 subjects (31%) with HR and 2 (6%) without HR (p = .023). The average follow-up duration was 126 ± 89 weeks. Our results have demonstrated that the reamputation rate after partial hallux amputation is significantly greater in patients with than in those without radiographic evidence of HR. Surgeons should evaluate patients for HR when planning partial hallux amputation and use adjuvant methods of offloading when HR is evident to prevent recurrent ulceration and reamputation.

  15. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot.

    Science.gov (United States)

    Rubio, José Antonio; Aragón-Sánchez, Javier; Jiménez, Sara; Guadalix, Gregorio; Albarracín, Agustín; Salido, Carmen; Sanz-Moreno, José; Ruiz-Grande, Fernando; Gil-Fournier, Nuria; Álvarez, Julia

    2014-03-01

    We analyzed the incidence of lower extremity amputations (LEAs) in the 3rd Health Care Area of Madrid before and after the March 2008 introduction of a multidisciplinary team for managing diabetic foot disease. We compared the amputation rates in people with and without diabetes during 2 periods: before (2001-2007) and after (2008-2011) the introduction of a Multidisciplinary Diabetic Foot Unit (MDFU). We also analyzed the trend of the amputation rates by joinpoint regression analysis and measured the annual percentage change (APC). During the study period, 514 nontraumatic LEAs were performed, 374 (73%) in people with diabetes and 140 (27%) in people without the disease. The incidence of LEAs showed a significant reduction in major amputations in people with diabetes, from 6.1 per 100 000 per year (95% confidence interval [CI] = 4.9 to 7.2), in the 2001 to 2007 period, to 4.0 per 100 000 per year (95% CI = 2.6 to 5.5) in the 2008 to 2011 period (P = .020). There were no changes in incidence of minor or total amputations in the diabetic population or in amputations in the nondiabetic population during the study period. Joinpoint regression analysis showed a significant reduction in the incidence of major LEAs in diabetic population with an APC of -6.6% (95% CI = -10.2 to -2.8; P = .003), but there were no other significant changes. This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the incidence of major amputations in patients with diabetes.

  16. Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems

    Science.gov (United States)

    Yusof, Nazri Mohd; Rahman, Jamalludin Ab; Zulkifly, Ahmad Hafiz; Che-Ahmad, Aminudin; Khalid, Kamarul Ariffin; Sulong, Ahmad Fadzli; Vijayasingham, Naveen

    2015-01-01

    INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems. PMID:26668408

  17. Very low survival rates after non-traumatic lower limb amputation in a consecutive series

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Holm, Gitte; Kirketerp-Møller, Klaus;

    2012-01-01

    The aim of this retrospective study was to evaluate factors potentially influencing short- and long-term mortality in patients who had a non-traumatic lower limb amputation in a university hospital. A consecutive series of 93 amputations (16% toe/foot, 33% trans-tibial, 9% through knee and 42......% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. Thirty days and 1-year mortality were 30 and 54%, respectively. Cox regression analysis demonstrated that the 30-day mortality...... was associated with older age (P = 0.01), and the number of co-morbidities (P = 0.04), when adjusted for gender, previous amputations, cause of and amputation level, and residential status. Thus, a patient with 4 or 5 co-morbidities (n = 20) was seven times more likely to die within 30 days, compared...

  18. Clinical Factors affecting Minor Amputation in Diabetic Foot Disease at Tengku Ampuan Afzan Hospital, Kuantan

    Science.gov (United States)

    ZAKARIA, Zamzuri; AFIFI, Mustaqim; SHARIFUDIN, Mohd Ariff

    2015-01-01

    Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot. PMID:26023294

  19. Somatotype of the individuals with lower extremity amputation and its association with cardiovascular risk.

    Science.gov (United States)

    Mozumdar, Arupendra; Roy, Subrata K

    2008-03-01

    Anthropometric somatotyping is one of the methods to describe the shape of the human body, which shows some associations with an individual's health and disease condition, especially with cardiovascular diseases (CVD). Individuals with lower extremity amputation (LEA) are known to be more vulnerable to the cardiovascular risk. The objectives of the present study are to report the somatotype of the individuals having lower extremity amputation, to study the possible variation in somatotype between two groups of amputated individuals, and to study the association between cardiovascular disease risk factor and somatotype components among individuals with locomotor disability. 102 adult male individuals with unilateral lower-extremity amputation residing in Calcutta and adjoining areas were investigated. The anthropometric data for somatotyping and data on cardiovascular risk traits (such as body mass index, blood pressure measurements, blood lipids) have been collected. The somatotyping technique of Carter & Heath (1990) has been followed. The result shows high mean values of endomorphy and mesomorphy components and a low mean value of the ectomorphy component among the amputated individuals having cardiovascular risks. The results of both discriminant analysis and logistic regression analysis show a significant relationship between somatotype components and CVD risk among the individuals with LEA. The findings of the present study support the findings of similar studies conducted on the normal population. Diagnosis of CVD risk condition through somatotyping can be utilized in prevention/treatment management for the individuals with LEA. PMID:18435209

  20. Symmetrical kinematics does not imply symmetrical kinetics in people with transtibial amputation using cycling model

    Directory of Open Access Journals (Sweden)

    W. Lee Childers, PhD, CP

    2015-01-01

    Full Text Available People with amputation move asymmetrically with regard to kinematics (joint angles and kinetics (joint forces and moments. Clinicians have traditionally sought to minimize kinematic asymmetries, assuming kinetic asymmetries would also be minimized. A cycling model evaluated locomotor asymmetries. Eight individuals with unilateral transtibial amputation pedaled with 172 mm-length crank arms on both sides (control condition and with the crank arm length shortened to 162 mm on the amputated side (CRANK condition. Pedaling kinetics and limb kinematics were recorded. Joint kinetics, joint angles (mean and range of motion [ROM], and pedaling asymmetries were calculated from force pedals and with a motion capture system. A one-way analysis of variance with Tukey post hoc compared kinetics and kinematics across limbs. Statistical significance was set to p amputated limb compared with the control condition. There were no differences in joint kinematics between the contralateral and amputated limbs during the CRANK condition. Pedaling asymmetries did not differ and were 23.0% +/– 9.8% and 23.2% +/– 12.0% for the control and CRANK conditions, respectively. Our results suggest that minimizing kinematic asymmetries does not relate to kinetic asymmetries as clinically assumed. We propose that future research should concentrate on defining acceptable asymmetry.

  1. The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Wilken, Jason M

    2014-09-01

    Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations.

  2. Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study

    Directory of Open Access Journals (Sweden)

    Joseph B. Webster, MD

    2013-01-01

    Full Text Available Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.

  3. The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Wilken, Jason M

    2014-09-01

    Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations. PMID:25155692

  4. Feedforward control strategies of subjects with transradial amputation in planar reaching

    Directory of Open Access Journals (Sweden)

    Anthony J. Metzger, MBE

    2010-05-01

    Full Text Available The rate of upper-limb amputations is increasing, and the rejection rate of prosthetic devices remains high. People with upper-limb amputation do not fully incorporate prosthetic devices into their activities of daily living. By understanding the reaching behaviors of prosthesis users, researchers can alter prosthetic devices and develop training protocols to improve the acceptance of prosthetic limbs. By observing the reaching characteristics of the nondisabled arms of people with amputation, we can begin to understand how the brain alters its motor commands after amputation. We asked subjects to perform rapid reaching movements to two targets with and without visual feedback. Subjects performed the tasks with both their prosthetic and nondisabled arms. We calculated endpoint error, trajectory error, and variability and compared them with those of nondisabled control subjects. We found no significant abnormalities in the prosthetic limb. However, we found an abnormal leftward trajectory error (in right arms in the nondisabled arm of prosthetic users in the vision condition. In the no-vision condition, the nondisabled arm displayed abnormal leftward endpoint errors and abnormally higher endpoint variability. In the vision condition, peak velocity was lower and movement duration was longer in both arms of subjects with amputation. These abnormalities may reflect the cortical reorganization associated with limb loss.

  5. Comparison and Efficacy of LigaSure and Rubber Band Ligature in Closing the Inflamed Cecal Stump in a Rat Model of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Chun-Chieh Yeh

    2015-01-01

    Full Text Available Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A and 7 days (Group B after cecal resection, respectively. The cecal stumps were closed by silk ligature (S, 5 mm LigaSure (L, or rubber band (R. Seven days after cecal resection, the LigaSure (BL and silk subgroups (BS had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR. The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES.

  6. Comparison and efficacy of LigaSure and rubber band ligature in closing the inflamed cecal stump in a rat model of acute appendicitis.

    Science.gov (United States)

    Yeh, Chun-Chieh; Jan, Chia-Ing; Yang, Horng-Ren; Huang, Po-Han; Jeng, Long-Bin; Su, Wen-Pang; Chen, Hui-Chen

    2015-01-01

    Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, the LigaSure (BL) and silk subgroups (BS) had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR). The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES). PMID:25699264

  7. Traumatic partial amputation of the tongue. Case report and literature review

    Science.gov (United States)

    Hernández-Méndez, José Roberto; Rodríguez-Luna, María Rita; Guarneros-Zárate, Joaquín Eugenio; Vélez-Palafox, Mario

    2015-01-01

    Introduction The traumatic injuries to the tongue can go form section to partial or complete amputation, the latter being a rare presentation in the setting of facial trauma or even in patients with mental illness. Case report We present 25-year-old patient with traumatic partial amputation of the tongue who presented to the emergency department with successful surgical repair with good functional and esthetic outcome. Discussion The tongue can suffer a broad type of traumatic injuries, in the setting of active bleeding, the muscular planes must be closed with absorbable sutures to stop the hemorrhage and prevent hematoma formation. Tongue surgical repair in the setting of a total section requires integrity of arterial and venous flow, so anastomosis must be executed. Conclusion Amputation of the tongue can put the patient's life at risk and its management needs to be mastered by the surgeons treating polytraumatized patients. PMID:26900463

  8. A review of the long-term health outcomes associated with war-related amputation.

    Science.gov (United States)

    Robbins, Christopher B; Vreeman, Daniel J; Sothmann, Mark S; Wilson, Stephen L; Oldridge, Neil B

    2009-06-01

    The rate of war-related amputations in current U.S. military personnel is now twice that experienced by military personnel in previous wars. We reviewed the literature for health outcomes following war-related amputations and 17 studies were retrieved with evidence that (a) amputees are at a significant risk for developing cardiovascular disease; (b) insulin may play an important role in regulating blood pressure in maturity-onset obesity; (c) lower-extremity amputees are at risk for joint pain and osteoarthritis; (d) transfemoral amputees report a higher incidence of low back pain than transtibial amputees; and (e) 50 to 80% report phantom limb pain, with many amputees stating they were either told that their pain was imagined or their mental state was questioned. The consistency of the observations on health outcomes in these studies warrants careful examination for their implication in the contemporary treatment of war-related amputation.

  9. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations

    Directory of Open Access Journals (Sweden)

    Amanda Lezanski Gujda

    2015-01-01

    Full Text Available Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.

  10. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations.

    Science.gov (United States)

    Lezanski-Gujda, Amanda; Bingham, Jonathan L; Logemann, Nicholas F

    2015-01-01

    Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians. PMID:25657907

  11. Symmetrical kinematics does not imply symmetrical kinetics in people with transtibial amputation using cycling model.

    Science.gov (United States)

    Childers, W Lee; Kogler, Géza F

    2014-01-01

    People with amputation move asymmetrically with regard to kinematics (joint angles) and kinetics (joint forces and moments). Clinicians have traditionally sought to minimize kinematic asymmetries, assuming kinetic asymmetries would also be minimized. A cycling model evaluated locomotor asymmetries. Eight individuals with unilateral transtibial amputation pedaled with 172 mm-length crank arms on both sides (control condition) and with the crank arm length shortened to 162 mm on the amputated side (CRANK condition). Pedaling kinetics and limb kinematics were recorded. Joint kinetics, joint angles (mean and range of motion [ROM]), and pedaling asymmetries were calculated from force pedals and with a motion capture system. A one-way analysis of variance with tukey post hoc compared kinetics and kinematics across limbs. Statistical significance was set to p kinetic asymmetries as clinically assumed. We propose that future research should concentrate on defining acceptable asymmetry.

  12. Towards a Full Greenhouse Gas Budget at a Clear-Cut and Stump Harvested Boreal Forest Site in Sweden

    Science.gov (United States)

    Vestin, P.; Mölder, M.; Sundqvist, E.; Hellström, M.; Bâth, A.; Weslien, P.; Klemedtsson, L.; Lindroth, A.

    2012-04-01

    Clear-cutting and subsequent site preparation is common forest management practice in Sweden. In addition, stump harvesting (for bioenergy production) following clear-cutting has become more common in recent years. The net effects of clear-cutting/stump harvesting on greenhouse gas (GHG) fluxes are however not well-known. A full assessment of the benefits of any management practice has to include all greenhouse gases. Recent development of fast-response gas analyzers has made eddy covariance (EC) measurements of water vapor (H2O), carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) possible. The applicability of these analyzers is however limited by high cost and in some cases by high power demand. By using the so-called flux-gradient method, it is possible to use one set of gas analyzers for a multi-tower setup to reduce both cost and total power consumption. In addition, using the same analyzers for measurements at several plots reduces systematic errors and minimizes the need for calibration. The effects of clear-cutting and stump harvesting on GHG fluxes were studied at Norunda forest in central Sweden. Four different plots were established on a new clear-cut. All plots were clear-cut (early 2009) and site prepared (May 2010). Two of the plots were then stump harvested. On each of the plots, a 3 m high tower was erected and equipped for flux-gradient measurements of CO2, H2O, CH4(May 2010 - October 2011), and N2O (June 2011 - October 2011) exchanges. Friction velocities and sensible heat fluxes were measured by sonic anemometers (Gill Windmaster, Gill Instruments Ltd). Air was continuously sampled at two heights in the towers and gas concentrations were analyzed for CH4, CO2, H2O (LGR DLT-100, Los Gatos Research) and N2O (QCL Mini Monitor, Aerodyne Research). In addition, EC flux measurements of CO2 and H2O (Li-7500, LI-COR) were carried out on two of the plots (one of each treatment). The EC measurements allows for verification of CO2 and H2O fluxes

  13. Combat-related bridge synostosis versus traditional transtibial amputation: comparison of military-specific outcomes.

    Science.gov (United States)

    Plucknette, Benjamin F; Krueger, Chad A; Rivera, Jessica C; Wenke, Joseph C

    2016-04-01

    The aim of our study was to determine military-specific outcomes for transtibial amputations of US Service members using either the traditional technique (Burgess) or the Ertl technique. All US Service members sustaining transtibial, combat-related amputation from September 2001 through July 2011 were reviewed. Amputation type, mechanism of injury, time interval to amputation, age, sex, branch of service, rank, force, nature, and injury severity score were recorded. Outcomes were determined by analyzing military-specific medical review results, to include the following: Physical Evaluation Board Liaison Office (PEBLO) rating (0-100), PEBLO outcome (permanent retirement, temporary disability retirement, separation without benefits, continuation of active duty, or fit for redeployment), and the rate of redeployment. Amputation type (Ertl vs. Burgess) was determined by reviewing postoperative radiographs and radiology reports. Data from all of the above categories were compared for both Ertl and Burgess amputees. Of 512 subjects identified, 478 had radiographs or radiology reports distinguishing between Ertl or Burgess transtibial amputation. A total of 406 subjects underwent the Burgess procedure, and 72 subjects underwent the Ertl procedure. There was not a significant difference between the two groups in review board rating (p = 0.858), review board outcome (p = 0.102), or ability to deploy (p = 0.106); however, subjects that underwent the Ertl procedure remained on active duty at a significantly higher rate (p = 0.021). There is a higher rate of remaining on active duty using the Ertl technique. This study suggests that there is an improvement in functional outcome with the Ertl technique. PMID:26644067

  14. Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation.

    Science.gov (United States)

    Lin, Suh-Jen; Winston, Katie D; Mitchell, Jill; Girlinghouse, Jacob; Crochet, Karleigh

    2014-01-01

    Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=-0.46) and of the sound leg (r=-0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size.

  15. Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation.

    Science.gov (United States)

    Lin, Suh-Jen; Winston, Katie D; Mitchell, Jill; Girlinghouse, Jacob; Crochet, Karleigh

    2014-01-01

    Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=-0.46) and of the sound leg (r=-0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size. PMID:24731451

  16. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    OpenAIRE

    Imaizumi, Shu; Asai, Tomohisa; Kanayama, Noriaki; Kawamura, Mitsuru; Koyama, Shinichi

    2014-01-01

    Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb) has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phanto...

  17. Barriers and Facilitators of Participation in Sports : A Qualitative Study on Dutch Individuals with Lower Limb Amputation

    NARCIS (Netherlands)

    Bragaru, Mihai; van Wilgen, C. P.; Geertzen, Jan H. B.; Ruijs, Suzette G. J. B.; Dijkstra, Pieter U.; Dekker, Rienk

    2013-01-01

    Introduction: Although individuals with lower limb amputation may benefit from participation in sports, less than 40% do so. Aim: To identify the barriers and facilitators that influence participation in sports for individuals with lower limb amputation. Design: Qualitative study. Participants: Twen

  18. Four limb amputations due to peripheral gangrene from inotrope use – Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ang Chuan Han

    2015-01-01

    CONCLUSION: Microvascular spasm is a rare complication of inotrope use which may lead to extensive peripheral gangrene. Anecdotal reports of reversal agents have been discussed. Four limb amputations are a reasonable option especially if done in an elective setting after the gangrene has demarcated itself. Rehabilitation with prosthesis after 4 limb amputations can result in good functional outcome.

  19. Risk factors for amputation in extremities vascular injuries in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al Wahbi A

    2016-05-01

    Full Text Available Abdullah Al Wahbi, Salman Aldakhil, Saud Al Turki, Abdulrahman El Kayali, Hussein Al Kohlani , Abdulaziz Al Showmer Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia Abstract: Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies. Keywords: vascular injuries, extremities trauma, amputation, ischemia

  20. Impact of a diabetic foot care education program on lower limb amputation rate

    Directory of Open Access Journals (Sweden)

    Abdullah M Al-Wahbi

    2010-10-01

    Full Text Available Abdullah M Al-WahbiDepartment of Surgery, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyahd, Kingdom of Saudi ArabiaBackground: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.Method: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.Results: The before group contained 20 patients (17 males and the after group contained 21 patients (16 males. There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.Conclusion: The program, although evaluated at an early

  1. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2016-06-01

    Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

  2. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting.

    Science.gov (United States)

    Ramanujam, Crystal L; Zgonis, Thomas

    2016-01-01

    In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations. PMID:27283728

  3. Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

    OpenAIRE

    Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P.; Smith, Douglas G.

    2009-01-01

    Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These...

  4. Reconstruction of an amputated glans penis with a buccal mucosal graft: case report of a novel technique.

    Science.gov (United States)

    Aboutaleb, Hamdy

    2014-12-01

    Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Penis length was 3 cm. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. A buccal mucosal graft was applied to the distal part of the penis associated with meatotomy. The use of a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for late reconfiguration of the glans penis after amputation when penile size is suitable.

  5. Blindness, Diabetes, and Amputation: Alleviation of Depression and Pain through Thermal Biofeedback Therapy.

    Science.gov (United States)

    Needham, W. E.; And Others

    1993-01-01

    A 39-year-old man who was blind, diabetic, and had a double amputation with chronic renal failure and peripheral vascular disease was treated with thermal biofeedback to reduce his depression through increased self-control, to minimize pain, and to facilitate healing of a pregangrenous hand. On treatment discharge, his mental and physical states…

  6. An ICF-based education programme in amputation rehabilitation for medical residents in the Netherlands

    NARCIS (Netherlands)

    Geertzen, Jan H. B.; Rommers, G. M.; Dekker, Rienk

    2011-01-01

    Background and Aim: Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics a

  7. Computed tomography in low-back-pain after femur-amputation for osteogenic sarcoma

    International Nuclear Information System (INIS)

    Following amputation of a lower extremity for osteogenic sarcoma, the lumbar muscles receive an asymmetric strain. This predisposes to low-back-pain. When this occurs, tumour-recurrence must be excluded. This report demonstrates the usefulness of high-resolution computer tomography (CT) in this clinical situation. (orig.)

  8. Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation

    NARCIS (Netherlands)

    Vrieling, Aline H.; van Keeken, Helco G.; Schoppen, Tanneke; Hof, At L.; Otten, Bert; Halbertsma, Jan P. K.; Postema, Klaas

    2009-01-01

    Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process. Design: Prospective and descriptive study. Subjects: Fourteen subjects with a recent

  9. Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.

    LENUS (Irish Health Repository)

    Tawfick, Wael A

    2013-10-01

    Introduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm\\/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.

  10. Mobility in Elderly People With a Lower Limb Amputation : A Systematic Review

    NARCIS (Netherlands)

    Fortington, Lauren V.; Rommers, Gerardus M.; Geertzen, Jan H. B.; Postema, Klaas; Dijkstra, Pieter U.

    2012-01-01

    Elderly people with a lower limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. Mobility is key to regaining independence; however, the impact of multiple comorbidities in this patient group can make regaining mobility a particularly chal

  11. Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation.

    Science.gov (United States)

    Gaffney, Brecca M; Murray, Amanda M; Christiansen, Cory L; Davidson, Bradley S

    2016-03-01

    Patients with unilateral dysvascular transtibial amputation (TTA) have a higher risk of developing low back pain than their healthy counterparts, which may be related to movement compensations used in the absence of ankle function. Assessing components of segmental angular momentum provides a unique framework to identify and interpret these movement compensations alongside traditional observational analyses. Angular momentum separation indicates two components of total angular momentum: (1) transfer momentum and (2) rotational momentum. The objective of this investigation was to assess movement compensations in patients with dysvascular TTA, patients with diabetes mellitus (DM), and healthy controls (HC) by examining patterns of generating and arresting trunk and pelvis segmental angular momenta during gait. We hypothesized that all groups would demonstrate similar patterns of generating/arresting total momentum and transfer momentum in the trunk and pelvis in reference to the groups (patients with DM and HC). We also hypothesized that patients with amputation would demonstrate different (larger) patterns of generating/arresting rotational angular momentum in the trunk. Patients with amputation demonstrated differences in trunk and pelvis transfer angular momentum in the sagittal and transverse planes in comparison to the reference groups, which indicates postural compensations adopted during walking. However, patients with amputation demonstrated larger patterns of generating and arresting of trunk and pelvis rotational angular momentum in comparison to the reference groups. These segmental rotational angular momentum patterns correspond with high eccentric muscle demands needed to arrest the angular momentum, and may lead to consequential long-term effects such as low back pain.

  12. Amputation after failure or complication of total knee arthroplasty: prevalence, etiology and functional outcomes

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2013-09-01

    Full Text Available OBJECTIVE: Identify the etiology and incidence, as well to assess functional outcomes of patients, undergoing lower limb amputation after failure or complication of total knee arthroplasty. These patients were treated at the Center for Knee Surgery at the National Institute of Traumatology and Orthopedics (INTO, during the period of January 2001 to December 2010. METHODS: The patients were interviewed and their charts were retrospectively analyzed to evaluate their functional outcome. RESULTS: The incidence of amputation due to failure or complication of total knee arthroplasty was 0.41% in 2409 cases. Recurrent deep infection was the cause of amputation in 81% of cases, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequent germs. Vascular complications and periprosthetic fracture associated to metaphyseal bone loss were also causes of amputation. In our study, 44% of amputees patients were using orthesis and 62.5% have had the ability to walk. CONCLUSION: Incidence of 0.41%, being the main cause recurrent infection. The functional outcome is limited, and the fitting achieved in 44% of patients and only 62.5% are ambulatory.

  13. Decrease in (Major Amputations in Diabetics: A Secondary Data Analysis by AOK Rheinland/Hamburg

    Directory of Open Access Journals (Sweden)

    Melanie May

    2016-01-01

    Full Text Available Aim. In two German regions with 11.1 million inhabitants, 6 networks for specialized treatment of DFS were implemented until 2008. Data provided for accounting purposes was analysed in order to determine changes in the rate of diabetics requiring amputations in the years before and after the implementation. Method. Data covering 2.9 million people insured by the largest insurance company between 2007 and 2013 was analysed by the use of log-linear Poisson regression adjusted for age, gender and region. Results. The rate of diabetics needing major amputations fell significantly by 9.5% per year (p<0.0001 from 217 to 126 of 100,000 patients per year. The rate of diabetics needing amputations of any kind fell from 504 to 419 of 100,000 patients per year (p=0.0038. Discussion. The networks integrate health care providers in an organised system of shared care. They educate members of the medical community and the general public. At the same time, a more general disease management program for people with diabetes was implemented, which may also have contributed to this decrease. At the end of the observation period, the rate of diabetics requiring amputations was still high. For this reason, further expansion of organised specialized care is urgently needed.

  14. Taking Care of Your New Arm or Leg After an Amputation

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    This podcast provides health information on taking care of a new arm or leg after an amputation.  Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program.   Date Released: 2/18/2010.

  15. Instrumented Measurement of Balance and Postural Control in Individuals with Lower Limb Amputation: A Critical Review

    Science.gov (United States)

    Jayakaran, Prasath; Johnson, Gillian M.; Sullivan, S. John; Nitz, Jennifer C.

    2012-01-01

    Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks…

  16. The morphology and functions of the muscles around the hip joint after a unilateral transfemoral amputation

    NARCIS (Netherlands)

    Jaegers, Sonja Maria Héléne José

    1993-01-01

    This dissertation is concerned with the consequences of a transfemoral amputation for the morphology and functions of the muscles around the hip joint. Knowledge about and insight into the changes appearing in the morphology and functions of the hip muscles of transfemoral amputees are important to

  17. Lower limb amputation in Northern Netherlands : Unchanged incidence from 1991-1992 to 2003-2004

    NARCIS (Netherlands)

    Fortington, Lauren V.; Rommers, Gerardus M.; Postema, Klaas; van Netten, Jaap J.; Geertzen, Jan H. B.; Dijkstra, Pieter U.

    2013-01-01

    Background: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Des

  18. Total hip arthroplasty in a patient with arthrogryphosis and an ipsilateral above knee amputation.

    LENUS (Irish Health Repository)

    Leonard, Michael

    2010-10-01

    The authors present the case of a young man with arthrogryphosis multiplex congenita and an above knee amputation who underwent an ipsilateral total hip replacement. The unique aspects of the case and technical difficulties are highlighted. Follow-up at five years revealed an excellent clinical and radiological outcome.

  19. Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

    NARCIS (Netherlands)

    Bodde, Marlies I.; Schrier, Ernst; Krans, Hilde K.; Geertzen, J.H.B.; Dijkstra, Pieter U.

    2014-01-01

    Purpose: Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study

  20. Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot.

    Directory of Open Access Journals (Sweden)

    João Paulo Tardivo

    Full Text Available Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD, which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2. Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2-1886.5. The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.

  1. Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study

    Science.gov (United States)

    Rodrigues, Beverly T.; Vangaveti, Venkat N.

    2016-01-01

    Objective. The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods. A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results. The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions. Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.

  2. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations

    Directory of Open Access Journals (Sweden)

    Marco Iosa, PhD

    2014-07-01

    Full Text Available Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001, harmony (p < 0.001, and symmetry (p < 0.001 of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.

  3. Prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    Lyu Jima; Hao Xuezhi; Hui Zhouguang; Liang Jun; Zhou Zongmei; Feng Qinfu; Xiao Zefen

    2014-01-01

    Background The prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer (NSCLC) remains unclear.This study intends to identify the prognostic factors and to optimize treatments for these patients under update conditions.Methods The data of 124 NSCLC patients who underwent R1-resection at the bronchial stump was reviewed.There were 41 patients in the surgery group (S),21 in the postoperative radiotherapy (PORT) group (S+R),30 in the postoperative chemotherapy (POCT) group (S+C),and 32 in the PORT plus POCT group (S+R+C).The constitute proportion in different groups was tested using the X2 method,univariate analysis was performed using the Kaplan-Meier and log-rank method,and multivariate analysis was done using the Cox hazard regression with entry factors including age,sex,pathological type and stage,classification of the residual disease,and treatment procedure.The process was performed stepwise backward with a maximum iteration of 20 and an entry possibility of 0.05 as well as an excluded possibility of 0.10 at each step.Results In univariate analysis,survival was more favorable for patients with squamous cell carcinoma,early pathological T or N stage,and chemotherapy or radiotherapy.There was no significant difference in the survival for patients with different types of the residual disease,except for the difference between patients with carcinoma in situ and lymphangiosis carcinomatosa (P=0.030).The survival for patients receiving chemoradiotherapy was superior to that for those undergoing surgery alone (P=0.016).In multivariate analysis,the pathological type (HR 2.51,95% CI 1.59 to 3.96,P=0.000),pathological T (HR 1.29,95% CI 1.04 to 1.60,P=-0.021) or N stage (HR 2.04,95% CI 1.40 to 2.98,P=0.000),and chemotherapy (HR 0.24,95% CI 0.13 to 0.43,P=0.000) were independent prognostic factors.Conclusion Patients with squamous cell carcinoma,early pathological T or N stage,or receiving chemotherapy had a more favorable

  4. Popliteal artery injuries in an urban trauma center with a rural catchment area: do delays in definitive treatment affect amputation?

    Science.gov (United States)

    Simmons, Jon D; Gunter, Joseph W; Schmieg, Robert E; Manley, Justin D; Rushton, Fred W; Porter, John M; Mitchell, Marc E

    2011-11-01

    Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment. All adult patients admitted to the Level I trauma center, the University of Mississippi Medical Center, with a popliteal artery injury between January 2000 and December of 2007 were identified. Demographic information management and outcome data were collected. Body mass index, mangled extremity severity score (MESS), Guistilo open fracture score, injury severity score, and time from injury to vascular repair were examined. Fifty-one patients with popliteal artery injuries (53% blunt and 47% penetrating) were identified, all undergoing operative repair. There were nine amputations (17.6%) and one death. Patients requiring amputation had a higher MESS, 7.8 versus 5.3 (P amputation rate compared with those with penetrating trauma, 25.9 per cent versus 8.3 per cent (P = non significant). MESS, though not perfect, is the best predictor of amputation in patients with popliteal artery injuries. Morbid obesity is not a significant predictor for amputation in patients with popliteal artery injuries. Time from injury to repair of greater than 6 hours was not predictive of amputation. This study further demonstrates that a single scoring system should be used with caution when determining the need for lower extremity amputation.

  5. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb

    DEFF Research Database (Denmark)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal;

    2016-01-01

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation...... for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb....

  6. Normal nerve-fibres in the distal segment of nerves completely separated from the proximal stump for more than six months

    Directory of Open Access Journals (Sweden)

    Eros Abrantes Erhart

    1962-12-01

    Full Text Available Our experimental and histopathological findings of normal nerve-fibres in the distal and intermediate segments of nerves completely separated from the proximal stump for more than six months differs from those of previous observers, and the application of our observations in surgical reconstruction of about one hundred human nerves, chiefly from the upper limb, has resulted in appreciably great degrees of success in most cases.

  7. Walking Ability and Quality of Life in Subjects With Transfemoral Amputation: A Comparison of Osseointegration With Socket Prostheses.

    NARCIS (Netherlands)

    Meent, H. van de; Hopman, M.T.E.; Frolke, J.P.M.

    2013-01-01

    OBJECTIVE: To investigate walking ability and quality of life of osseointegrated leg prostheses compared with socket prostheses. DESIGN: Prospective case-control study. SETTING: University medical center. PARTICIPANTS: Subjects (N=22) with transfemoral amputation (1 bilateral) referred to our center

  8. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    OpenAIRE

    Jun Yao; Albert Chen; Todd Kuiken; Carolina Carmona; Julius Dewald

    2015-01-01

    This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR). As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via th...

  9. PERCEIVED INDEPENDENCE AND LIMITATIONS IN RISING AND SITTING DOWN AFTER REHABILITATION FOR A LOWER-LIMB AMPUTATION

    OpenAIRE

    de Laat, Fred A.; Dijkstra, Pieter U.; Rommers, Gerardus M.; Geertzen, Jan H. B.; Roorda, Leo D

    2014-01-01

    Objective: To study perceived independence in rising and perceived limitations in rising and sitting down in persons after a lower-limb amputation and the relationship of these perceptions with personal and clinical characteristics. Design: Cross-sectional study. Subjects/patients: Persons with a lower-limb amputation wearing a prosthesis (n=172). Methods: Perceived independence in rising was assessed with the Locomotor Capabilities Index. Limitations in rising and sitting down were assessed ...

  10. Dynamic Stability of Superior vs. Inferior Body Segments in Individuals with Transtibial Amputation Walking in Destabilizing Environments✰

    OpenAIRE

    Beurskens, Rainer; Wilken, Jason M.; Dingwell, Jonathan B.

    2014-01-01

    Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body...

  11. Types of psychological reactions in patients with lower-extremity amputations

    Directory of Open Access Journals (Sweden)

    Platiša Nedeljko

    2006-01-01

    Full Text Available The aim of this study was to establish types of psychological reactions and conditions in patients with lower-extremity amputations. Apart from using psychological interviews, detection was performed using psychometric tests: Minnesota Multiphasic Personality Inventory and Beck Depression Inventory. Psychometric parameters were analyzed in a group of 20 examinees treated at the Medical Rehabilitation Clinic in Novi Sad. Out of the whole sample. 45% of patients presented with adaptive reactions to amputation and consequent disability, whereas 55% presented with maladaptive responses. The registered psychopathological symptoms included nosologic categories: reaction to stressful events and adjustment disorder (predominantly affecting other emotions: mixed disorder of conduct and emotions: prolonged depressive reaction and dysthymia. When working with lower-extremity amputees, apart from adaptive, nonpathological forms of behavior, one also encounters maladaptive responses with predomination of mood disorders due to severe somatic stress. .

  12. Prosthetic ambulation in a paraplegic patient with a transfemoral amputation and radial nerve palsy.

    Science.gov (United States)

    Shin, J C; Park, C; Kim, D Y; Choi, Y S; Kim, Y K; Seong, Y J

    2000-08-01

    Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed. PMID:10992814

  13. Dynamic stability of running: The effects of speed and leg amputations on the maximal Lyapunov exponent

    Energy Technology Data Exchange (ETDEWEB)

    Look, Nicole [Department of Applied Mathematics, University of Colorado Boulder, Boulder, Colorado 80309 (United States); Arellano, Christopher J.; Grabowski, Alena M.; Kram, Rodger [Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado 80309 (United States); McDermott, William J. [The Orthopedic Specialty Hospital, Murray, Utah 84107 (United States); Bradley, Elizabeth [Department of Computer Science, University of Colorado Boulder, Boulder, Colorado 80309, USA and Santa Fe Institute, Santa Fe, New Mexico 87501 (United States)

    2013-12-15

    In this paper, we study dynamic stability during running, focusing on the effects of speed, and the use of a leg prosthesis. We compute and compare the maximal Lyapunov exponents of kinematic time-series data from subjects with and without unilateral transtibial amputations running at a wide range of speeds. We find that the dynamics of the affected leg with the running-specific prosthesis are less stable than the dynamics of the unaffected leg and also less stable than the biological legs of the non-amputee runners. Surprisingly, we find that the center-of-mass dynamics of runners with two intact biological legs are slightly less stable than those of runners with amputations. Our results suggest that while leg asymmetries may be associated with instability, runners may compensate for this effect by increased control of their center-of-mass dynamics.

  14. Canonical and non-canonical Wnt signaling control the regeneration of amputated rodent vibrissae follicles.

    Science.gov (United States)

    Yuan, Yan-Ping; Huang, Keng; Xu, Yan-Min; Chen, Xian-Cai; Li, Hai-Hong; Cai, Bo-Zhi; Liu, Yang; Zhang, Huan; Li, Yu; Lin, Chang-Min

    2016-02-01

    Although mammals are notoriously poor at regeneration compared with many lower-order species, the hair follicle, particular to mammals, is capable of regeneration following partial amputation. The detailed internal mechanism of this phenomenon is still unclear. Development and regrowth of the hair follicle depends on dermal-epidermal interaction within the hair follicle. Previous studies have shown that Wnt/β-catenin, Shh, Bmp, PDGF, TGF and Notch signals all take part in the development and growth of the hair follicle, and the Wnt/β-catenin signaling additionally plays an indispensable role in hair follicle morphogenesis and regrowth. In this study, we investigated the localization, as well as, protein levels of Wnt/β-catenin signaling molecules during amputated whisker follicle regeneration. PMID:26742765

  15. Amputees by choice: body integrity identity disorder and the ethics of amputation.

    Science.gov (United States)

    Bayne, Tim; Levy, Neil

    2005-01-01

    Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests. PMID:15948330

  16. Amputation-Free Survival after Crural Percutaneous Transluminal Angioplasty for Critical Limb Ischemia

    DEFF Research Database (Denmark)

    Strøm, M; Konge, L; Lönn, L;

    2016-01-01

    BACKGROUND AND AIM: To evaluate the amputation-free survival after below the knee percutaneous transluminal angioplasty in a consecutive group of patients with critical ischemia of the lower extremity. MATERIALS AND METHODS: A total of 70 consecutive patients with critical ischemia were treated...... with below the knee percutaneous transluminal angioplasty at the vascular center at Rigshospitalet with the purpose of limb salvage. All patients were deemed unfit for major surgery due to anatomical limitations or severe co-morbidity, and no prior attempts of revascularization were performed. Follow...... within the first year. Complications after percutaneous transluminal angioplasty were rare. Cumulative mortality after 1 and 2 years was 22% and 34%, respectively. Amputation-free survival at 1 and 2 years of follow-up was 68% and 58%, respectively. There were no association between known risk factors...

  17. The distal blood pressure predicts healing of amputations on the feet

    DEFF Research Database (Denmark)

    Holstein, P

    1984-01-01

    The healing of digital and transmetatarsal forefoot amputations was compared with the systolic digital and ankle blood pressure, both measured with a strain-gauge, and with the skin perfusion pressure on the forefoot measured with the isotope washout technique. In 85 out of 134 legs (63 per cent......) the amputation healed. The frequency of healing correlated statistically significantly with all three measures of distal blood pressures, the closest correlation being with the systolic digital blood pressure (SDBP). As measured in 110 cases the healing rates were: SDBP less than 20 mm Hg: four out of 23; SDBP...... 20-29 mm Hg: 13 out of 22; SDBP greater than or equal to 30 mm Hg: 51 out of 65. Ankle pressures and skin perfusion pressures were less useful. Invasive infection was present in 40 out of 102 diabetic legs and, next to ischaemia, was the major determinant of the healing results....

  18. Trip recoveries of people with unilateral, transfemoral or knee disarticulation amputations: Initial findings.

    Science.gov (United States)

    Crenshaw, Jeremy R; Kaufman, Kenton R; Grabiner, Mark D

    2013-07-01

    The purpose of this report is to provide novel findings from the kinematics of five amputees following a laboratory-induced trip. Only amputees with a unilateral, transfemoral or knee disarticulation amputation were included in this study. When the prosthesis was obstructed, all subjects used a lowering strategy, resulting in three harness-assisted recoveries and one fall. When the non-prosthetic limb was obstructed, one subject fell using an elevating strategy, one subject fell using a lowering strategy, and one subject, who was harness-assisted, used a hopping strategy. These results can be used to guide further studies of how to limit prosthetic knee flexion due to weight-bearing during a lowering strategy, implement compensatory step training to reduce fall risk, and identify appropriate, context-specific recovery strategies for people with transfemoral or knee disarticulation amputations.

  19. Effect of traumatic brain injury among U.S. servicemembers with amputation

    OpenAIRE

    Mitchell J. Rauh, PhD, PT, MPH; Hilary J. Aralis, MS; Ted Melcer, PhD; Caroline A. Macera, PhD; Pinata Sessoms, PhD; Jamie Bartlett, PhD; Michael R. Galarneau, MS

    2013-01-01

    Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputation and examine whether TBI status was associated with discharge to civilian status and medical and rehabilitative service use postamputation. U.S. s...

  20. Solitary Giant Intramuscular Myxoid Neurofibroma Resulting in an above Elbow Amputation

    Directory of Open Access Journals (Sweden)

    Gururajaparasad Chennakeshaviah

    2012-01-01

    Full Text Available Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry.

  1. Solitary Giant Intramuscular Myxoid Neurofibroma Resulting in an above Elbow Amputation

    Science.gov (United States)

    Chennakeshaviah, Gururajaparasad; Ravishankar, Sunila; Maggad, Rangaswamy; Manjunath, G. V.

    2012-01-01

    Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry. PMID:23198230

  2. Bionic ankle–foot prosthesis normalizes walking gait for persons with leg amputation

    OpenAIRE

    Herr, Hugh M.; Grabowski, Alena M

    2011-01-01

    Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biolog...

  3. Genital self-amputation or the Klingsor syndrome: Successful non-microsurgical penile replantation

    OpenAIRE

    El Harrech, Y.; Abaka, N.; Ghoundale, O.; D Touiti

    2013-01-01

    Self-mutilations of the external genitals in psychiatric patients also known as Klingsor syndrome is a rare urologic trauma. Men with religious conflicts, low self-esteem, unresolved transsexual issues and feelings of guilt are the most vulnerable. This condition requires immediate surgical intervention. Currently replantation involves meticulous microsurgery and has become the primary method for managing these patients. In this paper, we report a case of self amputation of penis in a patient...

  4. Newly diagnosed type 1 diabetes complicated by ketoacidosis and peripheral thrombosis leading to transfemoral amputation.

    Science.gov (United States)

    Jørgensen, Line Bisgaard; Skov, Ole; Yderstræde, Knud

    2014-01-01

    Peripheral vascular thromboembolism is a rarely described complication of diabetic ketoacidosis. We report a 41-year-old otherwise healthy man admitted with ketoacidosis and ischaemia of the left foot. The patient was unsuccessfully treated with thromboendarterectomy, and the extremity was ultimately amputated. The patient had no family history of cardiovascular disease, and all blood sample analyses for hypercoagulability were negative. We recommend an increased focus on peripheral thromboembolism, when treating patients with severe ketoacidosis.

  5. Transfemoral unilateral computerized analysis of march in amputated individuals with endoskeletal and exoskeletal prothesis

    OpenAIRE

    Claudia Patricia Pinzón✝,; Gina Paola López; Cárol Ávila; Jorge Enrique Correa; Melba Geomar Rodríguez

    2003-01-01

    Title: Computerized Gait Analysis in UnilateralTrans-Femoral Amputees with Endo-Skeleticand Exo-Skeletic Prosthesis. Case Study.The purpose of this study is to perform a computerized gait analysis in subjects with unilateraltrans-femoral amputation with endo-skeleticand exo-skeletic prosthesis. Method: Theparticipants were two soldiers of The ColombianNational Army, with trans-femoral (AK) unilateralamputation, because of traumatic cause, age(25+/-10 years). The Software Ariel PerformanceAnal...

  6. Active dorsiflexing prostheses may reduce trip-related fall risk in people with transtibial amputation

    Directory of Open Access Journals (Sweden)

    Noah J. Rosenblatt, PhD

    2015-01-01

    Full Text Available People with amputation are at increased risk of falling compared with age-matched, nondisabled individuals. This may partly reflect amputation-related changes to minimum toe clearance (MTC that could increase the incidence of trips and fall risk. This study determined the contribution of an active dorsiflexing prosthesis to MTC. We hypothesized that regardless of speed or incline the active dorsiflexion qualities of the ProprioFoot would significantly increase MTC and decrease the likelihood of tripping. Eight people with transtibial amputation walked on a treadmill with their current foot at two grades and three velocities, then repeated the protocol after 4 wk of accommodation with the ProprioFoot. A mixed-model, repeated-measures analysis of variance was used to compare MTC. Curves representing the likelihood of tripping were derived from the MTC distributions and a multiple regression was used to determine the relative contributions of hip, knee, and ankle angles to MTC. Regardless of condition, MTC was approximately 70% larger with the ProprioFoot (p < 0.001 and the likelihood of tripping was reduced. Regression analysis revealed that MTC with the ProprioFoot was sensitive to all three angles, with sensitivity of hip and ankle being greater. Overall, the ProprioFoot may increase user safety by decreasing the likelihood of tripping and thus the pursuant likelihood of a fall.

  7. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients.

    Science.gov (United States)

    Moura Neto, Arnaldo; Zantut-Wittmann, Denise Engelbrecht; Fernandes, Tulio Diniz; Nery, Marcia; Parisi, Maria Candida Ribeiro

    2013-08-01

    Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p diabetic foot (p diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.

  8. Revisiting risks associated with mortality following initial transtibial or transfemoral amputation

    Directory of Open Access Journals (Sweden)

    Barbara E. Bates, MD, MBA

    2013-01-01

    Full Text Available This study’s objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputation level, and more comorbidities increased mortality likelihood. Patients who had inpatient procedures for pulmonary and renal problems had higher hazards of postdischarge death than those who did not (hazard ratio [HR] = 2.10, 95% confidence interval [CI] = 1.16–3.77, and HR = 2.22, 95% CI = 1.80–2.74, respectively. Patients who had central nervous system procedures had higher hazards of death early postdischarge (HR = 2.23, 95% CI = 1.60–3.11 at 0 d, but this association became insignificant by 180 d. Patients in a surgical intensive care unit (ICU, medical ICU, or medical bed section at the time of discharge were more likely to die than patients on a surgical bed section. Patients hospitalized in the Midwest were less likely to die early after discharge than patients in the Mountain Pacific region, but this regional effect became insignificant by 90 d. Adding treatment-, environmental-, and facility-level characteristics contributed additional information to a mortality risk model.

  9. Cardiovascular risk factors among males with war-related bilateral lower limb amputation.

    Science.gov (United States)

    Shahriar, S H; Masumi, M; Edjtehadi, F; Soroush, M R; Soveid, M; Mousavi, B

    2009-10-01

    This study was conducted to determine the cardiovascular risk factors among 327 Iranian males with bilateral lower limb amputation.The average age at the time of amputation and at the time of the study was 20.6 (SD = 5.4) and 42 years (SD = 6.3), respectively. Below both knees was the most common level of amputation (37.6%). About 95.4% had at least one modifiable risk factor. Prevalence of risk factors included: hyperglycemia 13.1%, systolic hypertension 18.9%, diastolic hypertension 25.6%, abdominal obesity 82.5%, high total cholesterol 36.7%, low HDL 25.9%, high LDL 24.7%, high triglycerides 32.1%, and smoking 31.8%. The most common risk factor was abdominal obesity. Prevalence of coronary artery disease was similar to the general Iranian population but prevalence of risk factors was higher significantly. The majority of the cases seem to be susceptible to cardiovascular disease in near future. Some strategies are needed as a primary prevention to reduce the risk of cardiovascular disease.

  10. Global trends in incidence of lower limb amputation: a review of the literature

    Directory of Open Access Journals (Sweden)

    L. Godlwana

    2008-02-01

    Full Text Available The aim of this paper was to compile a literature report on the global epidemiology of lower limb amputations. Specifically it aimed at capturing information on the incidence of traumatic and non-traumatic lowerlimb amputations throughout the world, to identify the etiology including diseases and lifestyle habits associated with lower limb amputees (LLA in boththe developed and the developing countries, to identify the demographiccharacteristics, age, sex, race, geographical location of the people undergoing LLA including the levels of amputation as pointed out by the literature. Aliterature search was conducted. Different keyword combinations were used togather as much literature on the subject as possible. The authors systemicallyreviewed literature from some parts of Europe, Asia, North and South America and South Africa. The data was analyzed and presented under various themes. The existing literature shows that diabetes is the leading cause of LLA and trauma accounts for the minority of these cases. The incidence of LLA can be predicted by gender, age, maritalstatus, level of education and socio-economic status. Information on LLA in South Africa is almost absent.

  11. Unani treatment and leech therapy saved the diabetic foot of a patient from amputation.

    Science.gov (United States)

    Zaidi, S M Arif

    2016-04-01

    Every 30 seconds, a lower limb amputation is carried out due to diabetes throughout the world. The mortality rate due to diabetic foot gangrene is just next to that of cancer. As tissue death cannot be reversed, surgical removal of the affected tissue (debridement) or amputation of the limb is the only treatment option left when gangrene has advanced. The present case study illustrates an option to treat poorly healing diabetic wounds with Unani medicine (blood purifier and deobstruent) besides hirudotherapy. The study was performed on a 60-year-old woman suffering from diabetic foot (on the left) grade 5 and facing the prospect of imminent amputation. The patient was having severe pain (80 mm on a 100 mm visual analogue scale) in the gangrenous foot and foul-smelling with necrosed areas. Wound dressing was done with unripe papaya as it has a very good role in clearing necrotising area and hirudotherapy was also used in poorly healing wounds. The pain score decreased to 0-10 mm on a 100 mm visual analogue scale within 20 days and no further pain relieving medication was required. Over a time interval of nearly 3·5 months, necrotic areas disappeared and the wound was completely healed. PMID:24809835

  12. Evaluation of Gait Performance of a Hemipelvectomy Amputation Walking with a Canadian Prosthesis

    Directory of Open Access Journals (Sweden)

    M. T. Karimi

    2014-01-01

    Full Text Available Background. Hemipelvectomy amputation is a surgical procedure in which lower limb and a portion of pelvic are removed. There are a few studies in the literature regarding the performance of subjects with hip disarticulation during walking. However, there is no study on gait analysis of hemipelvectomy subject. Therefore, the aim of this paper was to evaluate the gait and stability of subject with hemipelvectomy amputation. Case Description and Methods. A subject with hemipelvectomy amputation at right side was involved in this study. He used a Canadian prosthesis with single axis ankle joint, 3R21 knee joint, and 7E7 hip joint for more than 10 years. The kinetic and kinematic parameters were collected by a motion analysis system and a Kistler force platform. Findings and Outcomes. There was a significant difference between knee, hip, and ankle range of motions and their moments in the sound and prosthesis sides. In the other side, the stability of the subject in the anteroposterior direction seems to be better than that in the mediolateral direction. Conclusions. There was a significant asymmetry between the kinetic and kinematic performance of the sound and prosthesis sides, which may be due to lack of muscular power and alignment of prosthesis components.

  13. Simultaneous toe-to-hand transfer and lower extremity amputations for severe upper and lower limb defects: the use of spare parts.

    Science.gov (United States)

    Chang, J; Jones, N F

    2002-06-01

    From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery.

  14. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Chi-Lun Huang

    Full Text Available OBJECTIVE: The clinical implication of the coronary artery calcium score (CS is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. METHODS AND RESULTS: Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03. During the follow-up period (21±11 months, 29 (35% patients underwent amputation, and 24 (29% patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03 and a 5.16-fold (95% CI 1.13-21.61, p = 0.04 higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. CONCLUSION: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

  15. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey

    Science.gov (United States)

    Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad

    2016-01-01

    Introduction  The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. Materials & methods  A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA).  Results  All patients were male. Most had traumatic amputation (119), were between 20–40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. Conclusions  This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448

  16. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey.

    Science.gov (United States)

    Rathore, Farooq A; Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad

    2016-01-01

    INTRODUCTION : The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. MATERIALS & METHODS : A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA). RESULTS : All patients were male. Most had traumatic amputation (119), were between 20-40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. CONCLUSIONS : This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448

  17. L'influence de l' "eye movement desensitization and reprocessing" sur la douleur fantôme des patients amputés

    OpenAIRE

    Grand, Kevin; Bonny, Marion; Portuesi, Vito

    2015-01-01

    Introduction : Les douleurs fantômes sont présentes chez 70 à 90 % des sujets suite à une amputation. Ces douleurs influencent négativement le quotidien des amputés. Il existe de nombreux traitements, mais aucun ne fait l’unanimité. Problématique : L’incidence des amputations est exponentielle à l’augmentation du nombre de personnes présentant une atteinte vasculaire. Différents changements s’effectuent lors d’une amputation, notamment au niveau du système nerveux qui engendre fréquemment des...

  18. Temporal Trends and Geographic Variation of Lower Extremity Amputation in Patients with Peripheral Artery Disease: Results from U.S. Medicare 2000–2008

    Science.gov (United States)

    Jones, W. Schuyler; Patel, Manesh R.; Dai, David; Subherwal, Sumeet; Stafford, Judith; Calhoun, Sarah; Peterson, Eric D.

    2014-01-01

    Objectives We sought to characterize temporal trends, patient-specific factors and geographic variation associated with amputation in patients with lower extremity peripheral artery disease (LE PAD) during the study period. Background Amputation represents the end stage failure for those with LE PAD and little is known about the rates and geographic variation in use of LE amputation. Methods Using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000 to December 31, 2008, we examined national patterns of LE amputation among patients 65 years or older with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors. Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation declined from 7,258 per 100,000 PAD patients to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI, 0.95-0.95, p<0.001). Conclusions From 2000 to 2008, LE amputation rates decreased significantly among PAD patients. There however remains significant patient and geographic variation in amputation rates across the United States. PMID:23103040

  19. Constitutive activation with overexpression of the mTORC2-phospholipase D1 pathway in uterine leiomyosarcoma and STUMP: morphoproteomic analysis with therapeutic implications.

    Science.gov (United States)

    Dhingra, Sadhna; Rodriguez, Michelle E; Shen, Qi; Duan, Xuizhen; Stanton, Melissa L; Chen, Lei; Zhang, Rongzhen; Brown, Robert E

    2011-01-01

    The mammalian target of rapamycin (mTOR) is centrally involved in growth, survival and metabolism. In cancer, mTOR is frequently hyperactivated and is a clinically validated target for therapy and drug development. Biologically, mTOR acts as the catalytic subunit of two functionally distinct complexes, called mTOR complex 1 (mTORC1) which is predominantly cytoplasmic in subcellular localization and mTOR complex 2 (mTORC2) which is both cytoplasmic and nuclear. mTORC1 is sensitive to the selective inhibitor rapamycin. By contrast, mTORC2 is relatively resistant to rapamycin. Moreover, its putative downstream effector, Akt phosphorylated on serine 473 represents a signal transduction pathway for tumor survival. Phospholipase D (PLD) and its product, phosphatidic acid (PA) have been implicated as an activator of mTOR signaling, including the direct phosphorylative activation of p70S6K atthreonine 389. The latter promotes cell cycle progression. In this study, we investigated the activation status and subcellular localization of mTOR and the relative expression of PLD1, as well as their downstream effectors in a spectrum of uterine smooth muscle tumors using normal myometria as controls. The results show significant activation with overexpression of phosphorylated mTORC2 complex in uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential (STUMP) as evidenced by nuclear localization of p-mTOR (Ser 2448) in ULMS>STUMP>uterine leiomyoma and normal myometria (p<0.05) and with overexpression of PLD1(p<0.05). Cor-relatively, there are overexpressions of nuclear p-Akt (Ser 473) and nuclear p-p70S6K (Thr 389) in ULMS and STUMP (p<0.05). The activation with overexpression of components of the mTORC2-PLD1 pathway in ULMS and to a lesser degree in STUMP provides insight into their tumorigenic mechanisms. Thus the development of therapies designed to target mTORC2 and PLD1 activity may be beneficial in treating ULMS. PMID:21326806

  20. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations

    OpenAIRE

    Amanda Lezanski Gujda; Bingham, Jonathan L.; Logemann, Nicholas F

    2015-01-01

    Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hy...

  1. Yubitsume: ritualistic self-amputation of proximal digits among the Yakuza

    Directory of Open Access Journals (Sweden)

    Anand Bosmia

    2014-07-01

    Full Text Available Abstract: Yubitsume is the ritualistic self-amputation of the proximal digits at the distal interphalangeal joint (DIP among members of the Japanese mafia, or yakuza. This practice of self-mutilation is done as a sign of apology for making a mistake deemed punishable by higher-ranking members or violating the code of the yakuza. Members of the yakuza may present to emergency departments seeking medical assistance to stop hemorrhage or treat infection at the site of injury following selfamputation or to have the severed portion of the injured finger reattached.

  2. Controlled environment treatment (CET) for patients with below-knee amputations.

    Science.gov (United States)

    Kegel, B

    1976-12-01

    This paper describes a new approach to early postsurgical wound management of the patient with a below-knee amputation. The method involves using the Controlled Environment Treatment (CET) machine, which wasdeveloped in England. A brief explanation of the components of the machine and its capabilities are listed. Ambient pressure, temperature, sterility, and humidity are easily controllable; advantages and disadvantages of this device over immediate post-operative plaster and conventional dressings as they relate both to wound environment and to physical therapy are mentioned. The early postsurgical therapy program used at Prosthetics Research Study is outlined.

  3. Intra-articular synovial sarcoma treated with a transfemoral amputation: a case report and review of the literature.

    Science.gov (United States)

    Gresswell, Steven D; Corsini, Anthony A; Balsamo, Luke H; Miles, Edward F

    2013-08-01

    A case of monophasic intra-articular synovial sarcoma in the right knee of a 39-year-old active duty serviceman treated with a transfemoral amputation is presented. The patient was evaluated for right knee pain and fullness. After further workup, the patient underwent computed tomography guided biopsy, with the tissue specimen consistent with intra-articular synovial sarcoma. The patient elected for a transfemoral amputation rather than limb or joint-sparing surgery. The gross specimen measured 3.5 × 3.0 × 1.7 cm in the posteromedial knee. No metastatic lesions were seen on positron emission tomography-computed tomography. Chemotherapy and radiation therapy have not been utilized. The transfemoral amputation adds to the uniqueness of this report and is discussed with a review of the multimodality treatment toward intra-articular synovial sarcoma in prior published literature.

  4. Dynamic stability of superior vs. inferior body segments in individuals with transtibial amputation walking in destabilizing environments.

    Science.gov (United States)

    Beurskens, Rainer; Wilken, Jason M; Dingwell, Jonathan B

    2014-09-22

    Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able-bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower-leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body respond to continuous visual or mechanical perturbations during walking. Nine persons with transtibial amputation (TTA) and 12 able-bodied controls (AB) walked on a 2 m × 3 m treadmill in a Computer Assisted Rehabilitation Environment (CAREN). Subjects were perturbed by continuous pseudo-random mediolateral movements of either the treadmill platform or the visual scene. TTA maintained a similar local and orbital stability in their superior body segments as AB throughout both perturbation types. However, for their inferior body segments, TTA subjects exhibited greater dynamic instability during perturbed walking. In TTA subjects, these increases in instability were even more pronounced in their prosthetic limb compared to their intact leg. These findings demonstrate that persons with unilateral lower leg amputation maintain upper body stability in spite of increased dynamic instability in their impaired lower leg. Thus, transtibial amputation does significantly impair sensorimotor function, leading to substantially altered dynamic movements of their lower limb segments. However, otherwise relatively healthy patients with unilateral transtibial amputation appear to retain sufficient remaining sensorimotor function in their proximal and contralateral limbs to adequately compensate for their impairment.

  5. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland.

    LENUS (Irish Health Repository)

    Buckley, Claire M

    2012-01-01

    To describe trends in the incidence of non-traumatic amputations among people with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a lower extremity amputation compared to an individual without diabetes in the Republic of Ireland.

  6. Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting

    DEFF Research Database (Denmark)

    Hedetoft, Christoffer; Rasmussen, Anne; Fabrin, Jesper;

    2008-01-01

    AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior to ...

  7. The Use of the 6-Min Walk Test as a Proxy for the Assessment of Energy Expenditure during Gait in Individuals with Lower-Limb Amputation

    Science.gov (United States)

    Kark, Laurena; McIntosh, Andrew S.B; Simmons, Annea

    2011-01-01

    The objective of this study was to determine, and compare, the utility of the 6-min walk test (6 MWT) and self-selected walking speed over 15 m as proxies for the assessment of energy expenditure during gait in individuals with lower-limb amputation. Patients with unilateral, transfemoral amputation (n = 6) and patients with unilateral,…

  8. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Energy Technology Data Exchange (ETDEWEB)

    Wurdeman, Shane R., E-mail: shanewurdeman@gmail.com [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Advanced Prosthetics Center, Omaha, Nebraska 68134 (United States); Myers, Sara A. [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Stergiou, Nicholas [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198 (United States)

    2014-03-15

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  9. Soccer Practice and Functional and Social Performance of Men With Lower Limb Amputations

    Directory of Open Access Journals (Sweden)

    Monteiro Rogeria

    2014-12-01

    Full Text Available Practicing sports together with rehabilitative treatment improves the development of motor, social and emotional abilities of lower limb amputees. The aim of this study was to compare the functional and social performance of individuals with lower limb amputations between those who played soccer and those who did not engage in any sports activities. A total of 138 individuals participated in the study and were divided into two groups: soccer players (n = 69, 34 ± 8.1 years and non-athletes (n = 69, 38 ± 8.9 years. A checklist, based on the International Classification of Functioning, Disability and Health, was used. Data were analyzed using the Chi-square and Mann-Whitney tests. The soccer players group showed significantly better performance than the non-athletes group in most items of body function, body structure, occupational performance components and daily activities (p < 0.001 for all, and also in some important items of social and environment factors (p < 0.001 for all. The results strongly suggest that amputee soccer significantly improves the functional and social performance in individuals with lower limb amputations.

  10. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Science.gov (United States)

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2014-03-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  11. Leg amputation following intramuscular injection of iron dextran in a 32 year old woman

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    Gloria Shalviri

    2015-10-01

    Full Text Available To inform healthcare professionals of a rare serious reaction leading to leg amputation following intramuscular injection of iron dextran and report comments for preventing such reactions.A case of leg amputation following intramuscular injection of iron dextran reported to Iranian Pharmacovigilance Center was reviewed. Patient and reaction data was collected by assessing the reported yellow card, patient chart review and interviewing with patient and physicians. World Health Organization definition for serious reactions was used to determine the seriousness of the reaction. Naranjo algorithm was used to determine probability scale. The probability of the reaction was determined based on questionnaire of Schumock et al. The studied case is classified as a rare and serious but preventable reaction induced by intramuscular injection of iron dextran in a 32 year old woman. The probability of the reaction is appeared to be “probable” based on Naranjo algorithm. It seems that Iron dextran could cause serious and life threatening adverse effects. It is necessary for healthcare professionals to be informed of such rare but serious reaction in order to apply preventive actions.

  12. Registering a methodology for imaging and analysis of residual-limb shape after transtibial amputation

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    Alexander S. Dickinson, PhD

    2016-03-01

    Full Text Available Successful prosthetic rehabilitation following lower-limb amputation depends upon a safe and comfortable socket-residual limb interface. Current practice predominantly uses a subjective, iterative process to establish socket shape, often requiring several visits to a prosthetist. This study proposes an objective methodology for residual-limb shape scanning and analysis by high-resolution, automated measurements. A 3-D printed "analog" residuum was scanned with three surface digitizers on 10 occasions. Accuracy was measured by the scan-height error between repeat analog scans and the computer-aided design (CAD geometry and the scan versus CAD volume. Subsequently, 20 male residuum casts from ambulatory individuals with transtibial amputation were scanned by two observers, and 10 were repeat-scanned by one observer. The shape files were aligned spatially, and geometric measurements were extracted. Repeatability was evaluated by intraclass correlation, Bland-Altman analysis of scan volumes, and pairwise root-mean-square error ranges of scan area and width profiles. Submillimeter accuracy was achieved when scanning the analog shape using white light and laser scanning technologies. Scanning male residuum casts was highly repeatable within and between observers. The analysis methodology technique provides clinical researchers and prosthetists the capability to establish their own quantitative, objective, multipatient datasets. This could provide an evidence base for training, long-term follow-up, and interpatient outcome comparison, for decision support in socket design.

  13. Expression of secreted Wnt pathway components reveals unexpected complexity of the planarian amputation response.

    Science.gov (United States)

    Gurley, Kyle A; Elliott, Sarah A; Simakov, Oleg; Schmidt, Heiko A; Holstein, Thomas W; Sánchez Alvarado, Alejandro

    2010-11-01

    Regeneration is widespread throughout the animal kingdom, but our molecular understanding of this process in adult animals remains poorly understood. Wnt/β-catenin signaling plays crucial roles throughout animal life from early development to adulthood. In intact and regenerating planarians, the regulation of Wnt/β-catenin signaling functions to maintain and specify anterior/posterior (A/P) identity. Here, we explore the expression kinetics and RNAi phenotypes for secreted members of the Wnt signaling pathway in the planarian Schmidtea mediterranea. Smed-wnt and sFRP expression during regeneration is surprisingly dynamic and reveals fundamental aspects of planarian biology that have been previously unappreciated. We show that after amputation, a wounding response precedes rapid re-organization of the A/P axis. Furthermore, cells throughout the body plan can mount this response and reassess their new A/P location in the complete absence of stem cells. While initial stages of the amputation response are stem cell independent, tissue remodeling and the integration of a new A/P address with anatomy are stem cell dependent. We also show that WNT5 functions in a reciprocal manner with SLIT to pattern the planarian mediolateral axis, while WNT11-2 patterns the posterior midline. Moreover, we perform an extensive phylogenetic analysis on the Smed-wnt genes using a method that combines and integrates both sequence and structural alignments, enabling us to place all nine genes into Wnt subfamilies for the first time. PMID:20707997

  14. Reconstruction of Punitive Ear Amputations in Uganda: A Unique Surgical Burden of Disease.

    Science.gov (United States)

    Dusseldorp, Joseph; Hodges, Andrew; Patel, Anup; Marchac, Alexandre; Firmin, Françoise

    2015-06-01

    Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures. PMID:26080156

  15. Regeneration of soft tissues is promoted by MMP1 treatment after digit amputation in mice.

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    Xiaodong Mu

    Full Text Available The ratio of matrix metalloproteinases (MMPs to the tissue inhibitors of metalloproteinases (TIMPs in wounded tissues strictly control the protease activity of MMPs, and therefore regulate the progress of wound closure, tissue regeneration and scar formation. Some amphibians (i.e. axolotl/newt demonstrate complete regeneration of missing or wounded digits and even limbs; MMPs play a critical role during amphibian regeneration. Conversely, mammalian wound healing re-establishes tissue integrity, but at the expense of scar tissue formation. The differences between amphibian regeneration and mammalian wound healing can be attributed to the greater ratio of MMPs to TIMPs in amphibian tissue. Previous studies have demonstrated the ability of MMP1 to effectively promote skeletal muscle regeneration by favoring extracellular matrix (ECM remodeling to enhance cell proliferation and migration. In this study, MMP1 was administered to the digits amputated at the mid-second phalanx of adult mice to observe its effect on digit regeneration. Results indicated that the regeneration of soft tissue and the rate of wound closure were significantly improved by MMP1 administration, but the elongation of the skeletal tissue was insignificantly affected. During digit regeneration, more mutipotent progenitor cells, capillary vasculature and neuromuscular-related tissues were observed in MMP1 treated tissues; moreover, there was less fibrotic tissue formed in treated digits. In summary, MMP1 was found to be effective in promoting wound healing in amputated digits of adult mice.

  16. The morphology of amputated human teeth and its relation to mechanical properties after restoration treatment

    Science.gov (United States)

    Gugger, Jonas; Krastl, Gabriel; Huser, Marius; Deyhle, Hans; Müller, Bert

    2010-09-01

    The increased susceptibility to fracture of root canal- and post-treated teeth is less affected by alterations of the dentin structure, but seems to crucially depend on the loss of coronal tooth substance. The surface, available for adhesion of the composite material in the root canal and in the coronal part of the tooth, is assumed to be of key importance for the fracture resistance. Thus, an appropriate three-dimensional method should be identified to determine the adhesive surface with necessary precision. For this purpose, severely decayed teeth were simulated decapitating clinical crowns. After root canal filling and post space preparation, impressions of the root canal and the amputation surface were obtained using silicone. Micro computed tomography scans of these impressions were acquired. For one selected specimen, an additional high-resolution scan was recorded at a synchrotron radiation source. Software of ImageLab served for the extraction of the amputation interface, the post surface and the post volume from the tomography data, which have been finally correlated with the Young's modulus and the maximal load derived from mechanical tests. The morphological parameters show a realistic relationship to the mechanical tests performed after the restoration treatments and are consequently important for improving the dental skills.

  17. Antihypertensive drug therapy and the risk of lower extremity amputations in pharmacologically treated type 2 diabetes patients

    NARCIS (Netherlands)

    Erkens, JA; Klungel, OH; Stolk, RP; Spoelstra, JA; Grobbee, DE; Leufkens, HGM

    2004-01-01

    Purpose The objective of this study was to determine the association between different antihypertensive drug therapies and lower extremity amputations (LEAs) in type 2 diabetes patients. Methods Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and data on hospital

  18. Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Bruun, Christine; Guassora, Ann Dorrit; Nielsen, Anni Brit Sternhagen;

    2014-01-01

    Abstract AIM: To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. METHODS: This study was based on the Diabetes Care in General Practice study and Danish...

  19. Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?

    NARCIS (Netherlands)

    IJmker, T.; Noten, S.; Lamoth, C. J.; Beek, P. J.; van der Woude, L. H. V.; Houdijk, H.

    2014-01-01

    The aim of this study was to examine whether impaired balance control is partly responsible for the increased energy cost of walking in persons with a lower limb amputation (LLA). Previous studies used external lateral stabilization to evaluate the energy cost for balance control; this caused a decr

  20. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity : Rehabilitation process and prosthetics. Part 2

    NARCIS (Netherlands)

    Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S.; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Duijzentkunst, Rob Smit; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

    2015-01-01

    Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis

  1. Curcumin upregulates S100 expression and improves regeneration of the sciatic nerve following its complete amputation in mice

    Institute of Scientific and Technical Information of China (English)

    Guo-min Liu; Kun Xu; Juan Li; Yun-gang Luo

    2016-01-01

    The repair of peripheral nerve injury after complete amputation is dififcult, and even with anastomosis, the rapid recovery of nerve function remains challenging. Curcumin, extracted from plants of the genus Curcuma, has been shown to have anti-oxidant and anti-inlfammatory properties and to improve sciatic nerve crush injury in rats. Here, we determined whether curcumin had neuroprotective effects following com-plete peripheral nerve amputation injury. BALB/c mice underwent complete sciatic nerve amputation, followed by an immediate epineurium anastomosis. Mice were intragastrically administered curcumin at doses of 40 (high), 20 (moderate), and 10 mg/kg/d (low) for 1 week. We found that myelin in the mice of the high-and moderate-dose curcumin groups appeared with regular shape, uniform thickness, clear boundary, and little hyperplasia surrounding the myelin. High and moderate doses of curcumin markedly improved both action potential amplitude of the sciatic nerves and the conduction velocity of the corresponding motor neurons, and upregulated mRNA and protein ex-pression of S100, a marker for Schwann cell proliferation, in L4–6 spinal cord segments. These results suggest that curcumin is effective in promoting the repair of complete sciatic nerve amputation injury and that the underlying mechanism may be associated with upregulation of S100 expression.

  2. Curcumin upregulates S100 expression and improves regeneration of the sciatic nerve following its complete amputation in mice.

    Science.gov (United States)

    Liu, Guo-Min; Xu, Kun; Li, Juan; Luo, Yun-Gang

    2016-08-01

    The repair of peripheral nerve injury after complete amputation is difficult, and even with anastomosis, the rapid recovery of nerve function remains challenging. Curcumin, extracted from plants of the genus Curcuma, has been shown to have anti-oxidant and anti-inflammatory properties and to improve sciatic nerve crush injury in rats. Here, we determined whether curcumin had neuroprotective effects following complete peripheral nerve amputation injury. BALB/c mice underwent complete sciatic nerve amputation, followed by an immediate epineurium anastomosis. Mice were intragastrically administered curcumin at doses of 40 (high), 20 (moderate), and 10 mg/kg/d (low) for 1 week. We found that myelin in the mice of the high- and moderate-dose curcumin groups appeared with regular shape, uniform thickness, clear boundary, and little hyperplasia surrounding the myelin. High and moderate doses of curcumin markedly improved both action potential amplitude of the sciatic nerves and the conduction velocity of the corresponding motor neurons, and upregulated mRNA and protein expression of S100, a marker for Schwann cell proliferation, in L4-6 spinal cord segments. These results suggest that curcumin is effective in promoting the repair of complete sciatic nerve amputation injury and that the underlying mechanism may be associated with upregulation of S100 expression. PMID:27651779

  3. The role of amputation as an outcome measure in cellular therapy for critical limb ischemia: implications for clinical trial design

    Directory of Open Access Journals (Sweden)

    Pearl Gregory J

    2011-09-01

    Full Text Available Abstract Background Autologous bone marrow-derived stem cells have been ascribed an important therapeutic role in No-Option Critical limb Ischemia (NO-CLI. One primary endpoint for evaluating NO-CLI therapy is major amputation (AMP, which is usually combined with mortality for AMP-free survival (AFS. Only a trial which is double blinded can eliminate physician and patient bias as to the timing and reason for AMP. We examined factors influencing AMP in a prospective double-blinded pilot RCT (2:1 therapy to control of 48 patients treated with site of service obtained bone marrow cells (BMAC as well as a systematic review of the literature. Methods Cells were injected intramuscularly in the CLI limbs as either BMAC or placebo (peripheral blood. Six month AMP rates were compared between the two arms. Both patient and treating team were blinded of the assignment in follow-up examinations. A search of the literature identified 9 NO-CLI trials, the control arms of which were used to determine 6 month AMP rates and the influence of tissue loss. Results Fifteen amputations occurred during the 6 month period, 86.7% of these during the first 4 months. One amputation occurred in a Rutherford 4 patient. The difference in amputation rate between patients with rest pain (5.6% and those with tissue loss (46.7%, irrespective of treatment group, was significant (p = 0.0029. In patients with tissue loss, treatment with BMAC demonstrated a lower amputation rate than placebo (39.1% vs. 71.4%, p = 0.1337. The Kaplan-Meier time to amputation was longer in the BMAC group than in the placebo group (p = 0.067. Projecting these results to a pivotal trial, a bootstrap simulation model showed significant difference in AFS between BMAC and placebo with a power of 95% for a sample size of 210 patients. Meta-analysis of the literature confirmed a difference in amputation rate between patients with tissue loss and rest pain. Conclusions BMAC shows promise in improving AMP

  4. In situ ∼2.0 Ma trees discovered as fossil rooted stumps, lowermost Bed I, Olduvai Gorge, Tanzania.

    Science.gov (United States)

    Habermann, Jörg M; Stanistreet, Ian G; Stollhofen, Harald; Albert, Rosa M; Bamford, Marion K; Pante, Michael C; Njau, Jackson K; Masao, Fidelis T

    2016-01-01

    The discovery of fossil rooted tree stumps in lowermost Lower Bed I from the western Olduvai Basin, Tanzania, age-bracketed by the Naabi Ignimbrite (2.038 ± 0.005 Ma) and Tuff IA (1.88 ± 0.05 Ma), provides the first direct, in situ, and to date oldest evidence of living trees at Olduvai Gorge. The tree relicts occur in an interval dominated by low-viscosity mass flow and braided fluvial sediments, deposited at the toe of a largely Ngorongoro Volcano-sourced volcaniclastic fan apron that comprised a widely spaced network of ephemeral braided streams draining northward into the Olduvai Basin. Preservation of the trees occurred through their engulfment by mass flows, post-mortem mold formation resulting from differential decay of woody tissues, and subsequent fluvially-related sediment infill, calcite precipitation, and cast formation. Rhizolith preservation was triggered by the interaction of root-induced organic and inorganic processes to form rhizocretionary calcareous root casts. Phytolith analyses were carried out to complete the paleoenvironmental reconstruction. They imply a pronounced seasonality and indicate a wooded landscape with grasses, shrubs, and sedges growing nearby, comparable to the low, open riverine woodland (unit 4c) along the Garusi River and tributaries in the Laetoli area. Among the tree stump cluster were found outsized lithic clasts and those consisting of quartzite were identified as Oldowan stone tool artifacts. In the context of hominin activity, the identification of wooded grassland in association with nearby freshwater drainages and Oldowan artifacts significantly extends our paleoenvironmental purview on the basal parts of Lower Bed I, and highlights the hitherto underrated role of the yet poorly explored western Olduvai Gorge area as a potential ecologically attractive setting and habitat for early hominins.

  5. Donovanosis with auto-amputation of penis in a HIV-2 infected person

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    Chandra Gupta T

    2008-01-01

    Full Text Available Donovanosis is a slowly progressive, granulomatous ulcerative disease , caused by Klebsiella (Calymmatobacterium granulomatis. The disease is known to persist for years together, leading to complications. A male patient aged 30 years with underlying HIV-2 infection presented to the department of STD with painful ulceration over the genital region of 5 months duration, with absence of penis. Tissue smear from the ulcer and histopathological examination revealed large histiocytes with intracellular Donovan bodies (Pund cell. A final diagnosis of donovanosis with auto-amputation of penis with HIV-2 infection was made. The old conventional medicines, viz. streptomycin, doxycycline and amoxycillin, were effective. Though HIV-2 infections are milder than HIV-1 infections in all aspects, donovanosis in this HIV-2 infected case presented with complications. However, since the CD4 count was 748 cells/cmm, the severity is attributed to the long standing nature and negligence by the patient, and not to possible immunodeficiency.

  6. Genital self-amputation or the Klingsor syndrome: Successful non-microsurgical penile replantation

    Directory of Open Access Journals (Sweden)

    Y El harrech

    2013-01-01

    Full Text Available Self-mutilations of the external genitals in psychiatric patients also known as Klingsor syndrome is a rare urologic trauma. Men with religious conflicts, low self-esteem, unresolved transsexual issues and feelings of guilt are the most vulnerable. This condition requires immediate surgical intervention. Currently replantation involves meticulous microsurgery and has become the primary method for managing these patients. In this paper, we report a case of self amputation of penis in a patient with a psychiatric history significant for schizopfrenia. Because of the unavailability of a microscope in our department, a non-microsurgical replantation without microscopic magnification was attempted. After surgery, normal appearance and function including a good normal voiding, sensation, and erections were observed.

  7. USE OF LOPINAVIR/RITONAVIR ASSOCIATED WITH ERGOTAMINE RESULTING IN FOOT AMPUTATION: BRIEF COMMUNICATION

    Directory of Open Access Journals (Sweden)

    Fernando Raphael de Almeida Ferry

    2014-06-01

    Full Text Available A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation.

  8. Use of lopinavir/ritonavir associated with ergotamine resulting in foot amputation: brief communication.

    Science.gov (United States)

    Ferry, Fernando Raphael de Almeida; Da Silva, Guilherme Almeida Rosa; Motta, Rogerio Neves; Carvalho, Ricardo de Souza; De Sá, Carlos Alberto Morais

    2014-01-01

    A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation. PMID:24879006

  9. High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

    Science.gov (United States)

    Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

    2015-01-01

    Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.

  10. Pendulating—A grounded theory explaining patients’ behavior shortly after having a leg amputated due to vascular disease

    Science.gov (United States)

    Madsen, Ulla Riis; Hommel, Ami; Bååth, Carina; Berthelsen, Connie Bøttcher

    2016-01-01

    Introduction Although the group of vascular leg amputated patients constitutes some of the most vulnerable and frail on the orthopedic wards, previous research of amputated patients has focused on patients attending gait training in rehabilitation facilities leaving the patient experience shortly after surgery unexplored. Understanding patients’ behavior shortly after amputation could inform health professionals in regard to how these vulnerable patients’ needs at hospital can be met as well as how to plan for care post-discharge. Aim To construct a grounded theory (GT) explaining patients’ behavior shortly after having a leg amputated as a result of vascular disease. Method In line with constructivist GT methodology, data from ethnographic observations and interviews were simultaneously collected and analyzed using the constant comparative method covering the patients’ experiences during the first 4 weeks post-surgery. Data collection was guided by theoretical sampling and comprised 11 patients. A GT was constructed. Results Patients went through a three-phased process as they realized they were experiencing a life-changing event. The first phase was “Losing control” and comprised the sub-categories “Being overwhelmed” and “Facing dependency.” The second phase was “Digesting the shock” and comprised the sub-categories “Swallowing the life-changing decision,” “Detecting the amputated body” and “Struggling dualism.” The third phase was “Regaining control” and comprised the sub-categories “Managing consequences” and “Building-up hope and self-motivation.” “Pendulating” was identified as the core category describing the general pattern of behavior and illustrated how patients were swinging both cognitively and emotionally throughout the process. Conclusion The theory of “Pendulating” offers a tool to understand the amputated patients’ behavior and underlying concerns and to recognize where they are in the

  11. Pendulating—A grounded theory explaining patients’ behavior shortly after having a leg amputated due to vascular disease

    Directory of Open Access Journals (Sweden)

    Ulla Riis Madsen

    2016-09-01

    Full Text Available Introduction: Although the group of vascular leg amputated patients constitutes some of the most vulnerable and frail on the orthopedic wards, previous research of amputated patients has focused on patients attending gait training in rehabilitation facilities leaving the patient experience shortly after surgery unexplored. Understanding patients’ behavior shortly after amputation could inform health professionals in regard to how these vulnerable patients’ needs at hospital can be met as well as how to plan for care post-discharge. Aim: To construct a grounded theory (GT explaining patients’ behavior shortly after having a leg amputated as a result of vascular disease. Method: In line with constructivist GT methodology, data from ethnographic observations and interviews were simultaneously collected and analyzed using the constant comparative method covering the patients’ experiences during the first 4 weeks post-surgery. Data collection was guided by theoretical sampling and comprised 11 patients. A GT was constructed. Results: Patients went through a three-phased process as they realized they were experiencing a life-changing event. The first phase was “Losing control” and comprised the sub-categories “Being overwhelmed” and “Facing dependency.” The second phase was “Digesting the shock” and comprised the sub-categories “Swallowing the life-changing decision,” “Detecting the amputated body” and “Struggling dualism.” The third phase was “Regaining control” and comprised the sub-categories “Managing consequences” and “Building-up hope and self-motivation.” “Pendulating” was identified as the core category describing the general pattern of behavior and illustrated how patients were swinging both cognitively and emotionally throughout the process. Conclusion: The theory of “Pendulating” offers a tool to understand the amputated patients’ behavior and underlying concerns and to recognize

  12. 全子宫切除术后阴道残端出血临床分析%Clinical analysis for Hysterectomy vaginal stump hemorrhage

    Institute of Scientific and Technical Information of China (English)

    王文兰

    2012-01-01

    OBJECTIVE To retrospectively analyzfe the clinical diagnosis and treatment measures for nhysterectomy following vaginal stump hemorrhage. METHODS 76 subjects with uterine fibroids were collected from March 2009 to April 2010, and they were randomly divided into control group and observation group, 38 cases in each group. The two groups were implemented in routine hysterectomy. The observation group taken pelvic peritoneal sutures and postoperative treatment after performing vaginal cuff. Then we observed the vaginal stump end of bleeding and vaginal stump local circumstance. RESULTS In the control group, 1 case showed 24h postoperative hemorrhage, 24 cases showed 24h-10d postoperative hemorrhage, 3 cases showed postoperative bleeding after 10d, 24h-10d hemorrhage accounted for 63.2% of the patients, and was significantly higher than that of the observation group (21.1%) {P < 0.05); 16 cases showed mild hemorrhage in the control group, 10 cases showed moderate hemorrhage, 2 cases showed severe bleeding, mild hemorrhage accounted for 42.1%, and was significantly higher than that of the observation group (18.4%). All patients had no growth of granulation tissue, 11 cases showed gut malabsorption in the control group (28.9%), 9 cases (23.7%) showed catgut shedding, 5 cases (13.2%) showed catgut set relaxation, 1 case (2.6%) showed surface hyperemia or dirty color, 1 case (2.6%) showed thin stitching, 1 case (2.6%) showed right comer vascular leakage tie after vaginal cuff, and the percentage of gut malabsorption, catgut shedding and catgut set relaxation were significantly higher than those in the observation group (P < 0.05). CONCLUSION Effective measures for patients with hysterectomy, can significantly reduce the vaginal stump hemorrhage rate, contribute to postoperative rehabilitation, effectively avoid the occurrence of cervical stump carcinoma.%目的 回顾性分析全子宫切除术后阴道残端出血的临床诊治措施.方法 2009年3月~2010年4

  13. Amputations and foot ulcers in patients newly diagnosed with Type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity

    DEFF Research Database (Denmark)

    Bruun, C; Siersma, V.; Guassora, A.D.;

    2013-01-01

    To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities....

  14. Post-amputation pain is associated with the recall of an impaired body representation in dreams-results from a nation-wide survey on limb amputees.

    Science.gov (United States)

    Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

    2015-01-01

    The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person's well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model.

  15. Management of diabetic foot disease and amputation in the Irish health system: a qualitative study of patients' attitudes and experiences with health services.

    LENUS (Irish Health Repository)

    Delea, Sarah

    2015-07-01

    Diabetes is an increasingly prevalent chronic illness that places a huge burden on the individual, the health system and society. Patients with active foot disease and lower limb amputations due to diabetes have a significant amount of interaction with the health care services. The purpose of this study was to explore the attitudes and experiences of foot care services in Ireland among people with diabetes and active foot disease or lower limb amputations.

  16. A prospective study of the importance of life goal characteristics and goal adjustment capacities in longer term psychosocial adjustment to lower limb amputation

    OpenAIRE

    Coffey, Laura; Gallagher, Pamela; Desmond, Deirdre

    2014-01-01

    Objective: To explore the life goal characteristics and goal adjustment capacities of persons with lower limb amputation on admission to rehabilitation, and to examine their efficacy as predictors of psychosocial outcomes 6 months post-discharge. Design: Prospective, descriptive. Setting: Two specialist inpatient rehabilitation facilities in Ireland. Subjects: A consecutive sample of 64 patients with lower limb amputation. Main measures: On admission to rehabilitation, life goal c...

  17. The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002-2011).

    Science.gov (United States)

    Lefebvre, Kristin M; Chevan, Julia

    2015-02-01

    The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002-2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002-2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective.

  18. The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002-2011).

    Science.gov (United States)

    Lefebvre, Kristin M; Chevan, Julia

    2015-02-01

    The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002-2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002-2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective. PMID:25659653

  19. Traction avulsion amputation of the major upper limb: a proposed new classification, guidelines for acute management, and strategies for secondary reconstruction.

    Science.gov (United States)

    Chuang, D C; Lai, J B; Cheng, S L; Jain, V; Lin, C H; Chen, H C

    2001-11-01

    Major replantation of a traction avulsion amputation is undertaken with the goal of not only the reestablishment of circulation, but also functional outcome. This type of amputation is characterized by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. Between 1985 and 1998, 27 cases were referred for secondary reconstruction following amputation of the upper extremity involving both arm and forearm. Replantation was performed by at least 12 qualified plastic surgeons using different approaches and management, resulting in different outcomes. Initial replantation management significantly affects the later reconstruction. For comparing studies and prognostic implications, the authors propose a new classification according to the level of injury to muscles and innervated nerves: type I, amputation at or close to the musculotendinous aponeurosis with muscles remaining essentially intact; type II, amputation within the muscle bellies but with the proximal muscles still innervated; type III, amputation involving the motor nerve or neuromuscular junction, thereby causing total loss of muscle function; and type IV, amputation through the joint; i.e., disarticulation of the elbow or shoulder joint. Some patients required further reconstruction for functional restoration after replantation, but some did not. Through this retrospective study based on the proposed classification system, prospective guidelines for the management of different types of traction avulsion amputation are provided, including the value of replantation, length of bone shortening, primary or delayed muscle or nerve repair, necessity of fasciotomy, timing for using free tissue transfer for wound coverage, and the role of functioning free muscle transplantation for late reconstruction. The final functional outcome can also be anticipated prospectively through this classification system.

  20. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael;

    2016-01-01

    was compared with historical and concurrent national controls in Denmark. Results - The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models...... adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25-0.91) and by 46% (HR =0.54, 95% CI: 0.35-0.86), respectively, in the intervention group....... The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation - With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year...

  1. Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID

    OpenAIRE

    Bottini, G.; Brugger, P; Sedda, A.

    2015-01-01

    Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric d...

  2. Feasibility of the Nintendo WiiFit™ for improving walking in individuals with a lower limb amputation

    Directory of Open Access Journals (Sweden)

    Bita Imam

    2013-08-01

    Full Text Available Objectives: To evaluate the feasibility of the Nintendo WiiFit™ as an adjunct to usual therapy in individuals with a lower limb amputation. Methods: The study was a Multiple Baseline (AB Single Subject Research Design. Subjects were ≥19 years old, had their first unilateral transtibial or transfemoral amputation  ≤12 months ago, and were participating in prosthetic training. WiiFit training was provided for 30 min, 5 times a week, for a minimum of 2 and a maximum of 6 weeks in addition to usual therapy. Feasibility indicators were safety, post-intervention fatigue and pain levels, adherence, and subject’s acceptability of the program as measured by the Short Feedback Questionnaire–modified (SFQ-M. The primary clinical outcome was walking capacity assessed by the 2 Minute Walk Test (2MWT. The secondary clinical outcomes were the Short Physical Performance Battery, L-test, and Activities-Specific Balance Confidence. Results: Subjects (4 transtibial; 2 transfemoral had a median age of 48.5 years (range = 45–59 years. No adverse events associated with the intervention occurred. Median pain and fatigue levels were 1.3 (range = 0.5–3.5 and 3.1 (range = 1.4–4.1, respectively. Median adherence was 80%. Subjects found the WiiFit enjoyable and acceptable (median SFQ-M = 35. Five subjects showed statistical improvement on the 2MWT and four on the secondary outcomes (p < 0.05. Conclusion: The WiiFit intervention was found to be feasible in individuals with unilateral lower limb amputation. This research provides the foundation for future clinical research investigating the use of the WiiFit as a viable adjunctive therapy to improve outcomes in individuals with unilateral lower limb amputation who are participating in prosthetic training.

  3. Adjustment to amputation and psychological distress: an examination of the intervening role of posttraumatic stress and posttraumatic growth

    OpenAIRE

    Mac Conaill, Susan

    2013-01-01

    Successful adjustment to amputation can be quantified in a number of ways. Physical measures such as prosthesis use, mobility indices, and activities of daily living have traditionally been suggested as outcome measures in the literature. More recently, the importance of psychological outcomes is gaining attention. This study was based in a regional prosthetic, orthotic, and limb-absence rehabilitation unit. It was developed in order to provide an overview of a range of issues affecting pa...

  4. Amputation in emergency situations: indications, techniques and Médecins Sans Frontières France's experience in Haiti

    OpenAIRE

    Herard, Patrick; Boillot, François

    2012-01-01

    PURPOSE: The decision to amputate is always difficult but becomes even harder in emergency situations, which usually present extra complicating factors. MSF EXPERIENCE: These include human factors (related to both the surgeon and the patient); poor or nonexistent medical facilities, especially in war conditions or resource-poor countries; and cultural and religious considerations. Médecins Sans Frontières (MSF) has developed a quick medical and logistical response that relies on surgical prot...

  5. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients.

    Science.gov (United States)

    Brånemark, R; Berlin, O; Hagberg, K; Bergh, P; Gunterberg, B; Rydevik, B

    2014-01-01

    Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended prostheses. The clinical development of osseointegrated percutaneous prostheses for patients with a TFA started in 1990, based on the long-term successful results of osseointegrated dental implants. Between 1999 and 2007, 51 patients with 55 TFAs were consecutively enrolled in a prospective, single-centre non-randomised study and followed for two years. The indication for amputation was trauma in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. The assessment of outcome included the use of two self-report questionnaires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36. The cumulative survival at two years' follow-up was 92%. The Q-TFA showed improved prosthetic use, mobility, global situation and fewer problems (all p < 0.001). The physical function SF-36 scores were also improved (p < 0.001). Superficial infection was the most frequent complication, occurring 41 times in 28 patients (rate of infection 54.9%). Most were treated effectively with oral antibiotics. The implant was removed in four patients because of loosening (three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at two years (92%) combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, supports the 'revolutionary change' that patients with TFA have reported following treatment with osseointegrated percutaneous prostheses.

  6. EFFECTIVENESS OF VACUUM SEALING DRAINAGE COMBINED WITH ANTI-TAKEN SKIN GRAFT FOR PRIMARY CLOSING OF OPEN AMPUTATION WOUND%封闭式负压引流联合反植皮一期闭合开放性创伤截肢创面的临床分析

    Institute of Scientific and Technical Information of China (English)

    廖前德; 许鉴; 翁晓军; 钟达; 刘志勤; 王成功

    2012-01-01

    面的理想方法之一.%Objective To observe the effectiveness of vacuum sealing drainage (VSD) combined with anti-taken skin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 and lune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method. The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-taken skin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size, preoperative albumin index, or injury time between 2 groups (P > 0.05). In test group, the redundant stump skin was used to prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome dealing after amputation, which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressure drainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, and conventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSD device was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times of dressing change, and the hospitalization days in test group were significantly better than those in control group [ 90.0% vs. 63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 + 0.5) times vs. (8.0 + 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively] (P < 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and two-point discrimination of wound in test group were better than those in control group, showing significant differences (P < 0.05). No obvious swelling occurred at the residual limbs in 2 groups. The 1 imb pain incidence and the residual limb length were better in test group than those in

  7. 上肢残肢的常规康复治疗和肌电信号反馈训练%The prosthetic rehabilitation and training of myoelectric signal for upper limb stumps

    Institute of Scientific and Technical Information of China (English)

    武继祥; 刘宏亮; 周贤丽; 林永辉; 赵正福; 陈东; 吴宗耀

    2008-01-01

    Objective To evaluate the effect of prosthetic rehabilitation and analyze the exercise training program with myoelectric signal for upper limb stumps.Methods Twenty canes with 22 upper limb stumps were treated with exercise for strength training,muscle contraction and control training and the complication of stump were managed.The myoelectrlc signal of upper limb stumps were detected and the stumps were trained with electronic biofeedback software system,including basic signal of biofeedback training and visual biofeedback training.Then the myoelectric prostheses were assembled.Results After prosthetic rehabilitation and myoelectfic signal training,there Wan no significant atrophy of muscle of stumps,muscle strength and range of motion of these twenty limb stumps increased.The amputees could control muscle contraction and grasp,pinch,wrist rotation,elbow extension or flexion consciously.Twenty myoelectrie prostheses were assembled.Conclusion The prosthetic rehabilitation and myoelectric signal training of limb stump is important for assembling myoelectric prosthesis.%目的 探讨上肢截肢患者的常规康复治疗、残肢肌电信号训练程序以及装配肌电假肢的方法 ,并观察其效果.方法 对20例截肢患者(22个残肢)进行常规康复治疗,包括肌力训练、肌肉收缩控制训练和残肢并发症的处理.采用德国Otto Bock公司提供的肌电信号检测和训练软件系统进行肌电信号训练(分为基础肌电信号训练和视觉反馈训练两个阶段),并装配肌电假肢.观察患者的治疗效果.结果 20例截肢患者22个残肢肌肉无明显萎缩,肌力好,关节活动范围无明显受限,患者能较好地控制残肢肌肉收缩.装配肌电假肢20例(20个),所有残肢均能有意识地引出肌电信号,控制假肢的手指打开、闭合以及腕关节的旋转或肘关节的屈伸.结论 残肢常规康复治疗和肌电信号训练对装配肌电假肢,实现有意识地控制假肢功能极为重要.

  8. Herbicidas e danos físicos em tocos de teca para controle de brotos após o desbaste Herbicides and physical damages in teak stumps to control of sprouts after thinning

    Directory of Open Access Journals (Sweden)

    Sidney Fernando Caldeira

    2012-10-01

    Full Text Available Tocos de árvores desbastadas de Tectona grandis apresentam rebrota intensa que compete com as árvores remanescentes. O objetivo deste trabalho foi avaliar a eficácia da aplicação isolada ou combinada de diferentes concentrações dos herbicidas picloram e triclopyr, associados ou não à aplicação de danos físicos, no controle dessas brotações. Em um povoamento com quatro anos de idade, os tocos foram tratados imediatamente após o desbaste. Em outro povoamento com seis anos, foram tratadas as brotações presentes nos tocos desbastados no ano anterior. Foi registrada a porcentagem de tocos mortos, o número de brotações por toco e as respectivas alturas. No primeiro ensaio, a aplicação combinada de picloram a 0,48% com triclopyr a 0,96%, associada a 20 rachas com machado matou todos os tocos. No segundo ensaio, a maior eficácia, 21,7%, foi registrada com roçada prévia das brotações e a aplicação de picloram a 0,96%. Após o desbaste, a aplicação isolada de picloram ou combinada com triclopyr associada ou não aos danos físicos é eficiente para controlar os brotos de teca. A aplicação nas rebrotas de tocos desbastados no ano anterior apresenta alguma eficiência, mas com menor percentual de tocos mortos em relação à aplicação após o desbaste.The stumps of thinning trees of Tectona grandis L.f. present intense sprouts that compete with the remaining trees. The efficacy of the control of sprouts with the herbicides picloram and triclopyr, associated or no it applications of physical damages, were evaluated. Immediately after thinning, in plantation with four years old, the stumps were treated, and in other plantation, with age of six, the sprouts of stumps thinned in the previous year, were treated. The percentage of died stumps, the number of sprouts by stump and the respective heights were registered. In the first trial, the combined application of picloram at 0.48% with triclopyr at 0.96%, associated a 20 cracks

  9. Transfemoral unilateral computerized analysis of march in amputated individuals with endoskeletal and exoskeletal prothesis

    Directory of Open Access Journals (Sweden)

    Claudia Patricia Pinzón✝,

    2003-12-01

    Full Text Available Title: Computerized Gait Analysis in UnilateralTrans-Femoral Amputees with Endo-Skeleticand Exo-Skeletic Prosthesis. Case Study.The purpose of this study is to perform a computerized gait analysis in subjects with unilateraltrans-femoral amputation with endo-skeleticand exo-skeletic prosthesis. Method: Theparticipants were two soldiers of The ColombianNational Army, with trans-femoral (AK unilateralamputation, because of traumatic cause, age(25+/-10 years. The Software Ariel PerformanceAnalysis System (APAS was employed forthe movement analysis. Information onkinematics, parameters and decisive of the gait,tilt of pelvis, length of step, the length long stride,the broad of step, the march of cadense, the indexof energy, consumption and the percentage ofthe periods of duration of the gait cycle was obtained. Results: The heady data werecompared among if and with a normal gait. Theresults are present in a comparative board.Conclusions: The use of this technology in theintervention physical therapy with amputatedpeople, throws exact data in all the variables of thestudy, what can improve the boarding of thesepeople in the prosthetic and to provide them thegait pattern’s reeducation the nearest thing to thenormal thing.

  10. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    Directory of Open Access Journals (Sweden)

    Alireza eGharabaghi

    2014-05-01

    Full Text Available Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. This bi-directional interface enabled us to explore the cortical physiology following long-term transhumeral amputation. In addition, we investigated neurofeedback of electrocorticographic brain activity related to the patient’s motor imagery to open his missing hand, i.e. phantom hand movement, for real-time control of a virtual hand prosthesis.Results: Both event-related brain potentials and cortical stimulation revealed mutually overlapping cortical representations of the phantom hand. Phantom hand movements could be robustly classified and the patient required only three training sessions to gain reliable control of the virtual hand prosthesis in an online closed-loop paradigm that discriminated between hand opening and rest. Conclusion: Epidural implants may constitute a powerful and safe alternative communication pathway between the brain and external devices for upper-limb amputees, thereby facilitating the integrated use of different signal sources for more intuitive and specific control of multi-functional devices in clinical use.

  11. Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

    Directory of Open Access Journals (Sweden)

    Louise Johnson, PhD

    2014-06-01

    Full Text Available Most clinically available prosthetic feet have a rigid attachment or incorporate an “ankle” device allowing elastic articulation during stance, with the foot returning to a “neutral” position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC. Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F. MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p = 0.03. On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the “toes down” foot angle throughout swing (p = 0.01. Walking speed also increased when using the hyA-F (p = 0.001 and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04, which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03, but this did not increase risk of tripping.

  12. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.

    Science.gov (United States)

    Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao

    2016-01-01

    A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb. PMID:26879749

  13. Impact of rehabilitation programs on dependency and functional performance of patients with major lower limb amputations

    Science.gov (United States)

    AlSofyani, Mohammad A.; AlHarthi, Abdulaziz S.; Farahat, Fayssal M.; Abuznadah, Wesam T.

    2016-01-01

    Objectives: To determine pattern and impact of physical rehabilitation on dependency and functional performance of patients. Methods: This retrospective chart review was carried out between July and August 2012 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were collected using demographic, clinical, and dependency assessment checklists. Results: Patients who underwent major lower limb amputations between January 2007 and April 2012 (n=121) were included in the study. There were 84 (69.4%) male and 37 (30.6%) female patients with a mean ± standard deviation of 63.3±17.4 years old. Diabetes mellitus was the most frequent cause in 63.6% of patients. Only one-third of the amputees (32.2%) have records of completion of their rehabilitation programs, although 20.7% of them completed the <50% of the scheduled rehabilitation sessions, 17.2% attended between 50% and 80%, and the remaining 62.1% attended more than 80% of the scheduled sessions. Muscle power scores in each side of the upper and lower limbs were significantly better following rehabilitation (p<0.0001). Basic functions of mobility and transfer have also significantly improved (p<0.05). Conclusions: Overall dependency and functional performance were significantly better following implementation of the physical rehabilitation programs. A multidisciplinary team approach is mandatory to improve compliance of patients toward the rehabilitation programs. PMID:27652362

  14. Rehabilitation for Translumbar Amputation (review)%经腰椎离断术后的康复

    Institute of Scientific and Technical Information of China (English)

    杨平; 曹学军

    2011-01-01

    经腰椎离断术又名半体切除,是指经某一腰椎将骨盆、盆腔内容物、双下肢及外生殖器全部切除.手术使患者失去了直立能力,通过医生、护士、假肢技师、物理治疗师、心理治疗师、职业康复和社会康复工作者等多学科合作,对患者进行术后综合康复,可以恢复人体外形,重建直立活动能力、生活自理能力、社会交往及职业劳动能力.本文主要从术后综合康复方面进行综述.%Translumbar amputation, also known as hemicorporectomy, is a life-saying procedure for patients with a life-threatening diagnosis but with a normal life expectancy. In the surgical procedure, the pelvis, pelvic contents, lower extremities and external genitalia are removed following transection of the lumbar spine. The operation makes the patient lose the ability of being upright.With the interdisciplinary cooperation of doctors, nurses, prosthetists, psychologists, vocational rehabilitation workers and social rehabilitation workers, the patient can realize most of independent activities of daily living through rehabilitation. The rehabilitation associated with the procedure is reviewed.

  15. Long-term activity in and among persons with transfemoral amputation

    Directory of Open Access Journals (Sweden)

    Elizabeth G. Halsne, CPO

    2013-07-01

    Full Text Available Although physical limitations associated with transfemoral amputation (TFA have been studied in laboratory settings, little is known about habitual activity within free-living environments. A retrospective analysis of 12 mo of step activity data was performed to quantify activity levels, variations, and patterns in 17 adults with unilateral TFA. Yearly, seasonal, and monthly average daily step counts and coefficients of variation (CoVs were examined to characterize mobility. Analysis by Medicare Functional Classification Level (MFCL was performed to explore relationships between clinical classification and performance. Subjects averaged 1,540 prosthetic steps/day, and activity generally increased with MFCL. Activity between MFCL-2 and -3 subjects was not significantly different, suggesting that ability to engage in habitual physical activity may be similar for these groups. Relative variation (CoV was 0.65 across subjects but was lower for those with higher activity levels. No significant differences in CoV by group were detected. Marked seasonal and monthly patterns in activity were identified. Warmer seasons and months generally promoted higher activity, but peak temperatures and humidity depressed activity. Results suggest that persons with TFA are greatly limited in regards to activity. Further, large variations within and between subjects may challenge the interpretation of step activity gathered over short periods of time.

  16. Long-term activity in and among persons with transfemoral amputation.

    Science.gov (United States)

    Halsne, Elizabeth G; Waddingham, Matthew G; Hafner, Brian J

    2013-01-01

    Although physical limitations associated with transfemoral amputation (TFA) have been studied in laboratory settings, little is known about habitual activity within free-living environments. A retrospective analysis of 12 mo of step activity data was performed to quantify activity levels, variations, and patterns in 17 adults with unilateral TFA. Yearly, seasonal, and monthly average daily step counts and coefficients of variation (CoVs) were examined to characterize mobility. Analysis by Medicare Functional Classification Level (MFCL) was performed to explore relationships between clinical classification and performance. Subjects averaged 1,540 prosthetic steps/day, and activity generally increased with MFCL. Activity between MFCL-2 and -3 subjects was not significantly different, suggesting that ability to engage in habitual physical activity may be similar for these groups. Relative variation (CoV) was 0.65 across subjects but was lower for those with higher activity levels. No significant differences in CoV by group were detected. Marked seasonal and monthly patterns in activity were identified. Warmer seasons and months generally promoted higher activity, but peak temperatures and humidity depressed activity. Results suggest that persons with TFA are greatly limited in regards to activity. Further, large variations within and between subjects may challenge the interpretation of step activity gathered over short periods of time.

  17. Functional and structural regeneration in the axolotl heart (Ambystoma mexicanum) after partial ventricular amputation.

    Science.gov (United States)

    Cano-Martínez, Agustina; Vargas-González, Alvaro; Guarner-Lans, Verónica; Prado-Zayago, Esteban; León-Oleda, Martha; Nieto-Lima, Betzabé

    2010-01-01

    "In the present study we evaluated the effect of partial ventricular amputation (PVA) in the heart of the adult urodele amphibian (Ambystoma mexicanum) in vivo on spontaneous heart contractile activity recorded in vitro in association to the structural recovery at one, five, 30 and 90 days after injury. One day after PVA, ventricular-tension (VT) (16 ± 3%), atrium-tension (AT) (46 ± 4%) and heart rate (HR) (58+10%) resulted lower in comparison to control hearts. On days five, 30 and 90 after damage, values achieved a 61 ± 5, 93 ± 3, and 98 ± 5% (VT), 60 ± 4, 96 ± 3 and 99 ± 5% (AT) and 74 ± 5, 84 ± 10 and 95 ± 10% (HR) of the control values, respectively. Associated to contractile activity recovery we corroborated a gradual tissue restoration by cardiomyocyte proliferation. Our results represent the first quantitative evidence about the recovery of heart of A. mexicanum restores its functional capacity concomitantly to the structural recovery of the myocardium by proliferation of cardiomyocytes after PVA. These properties make the heart of A. mexicanum a potential model to study the mechanisms underlying heart regeneration in adult vertebrates in vivo.

  18. Spatiotemporal Parameters of 100-m Sprint in Different Levels of Sprinters with Unilateral Transtibial Amputation

    Science.gov (United States)

    Hobara, Hiroaki; Hashizume, Satoru; Kobayashi, Yoshiyuki; Mochmaru, Masaaki

    2016-01-01

    The aim of this study was to investigate differences of the spatiotemporal parameters in a 100-m sprint among elite, sub-elite, and non-elite sprinters with a unilateral transtibial amputation. Using publicly available Internet broadcasts, we analyzed 125, 19, and 33 records from 30 elite, 12 sub-elite, and 22 non-elite sprinters, respectively. For each sprinter’s run, the average velocity, step frequency, and step length were calculated using the number of steps in conjunction with the official race time. Average velocity was greatest in elite sprinters (8.71±0.32 m/s), followed by the sub-elite (8.09±0.06 m/s) and non-elite groups (7.72±0.27 m/s). Although there was a significant difference in average step frequency between the three groups, the effect size was small and the relative difference among the three groups was 3.1%. Statistical analysis also revealed that the average step length was longest in elite sprinters, followed by the sub-elite and non-elite groups. These results suggest that the differences in sprint performance between the three groups is mainly due to the average step length rather than step frequency. PMID:27701443

  19. Behavioral outcomes following below-knee amputation in the coordination between balance and leg movement.

    Science.gov (United States)

    Mouchnino, L; Mille, M-L; Martin, N; Baroni, G; Cincera, M; Bardot, A; Delarque, A; Massion, J; Pedotti, A

    2006-08-01

    Lateral leg movement is accompanied by opposite movements of the supporting leg and trunk segments. This kinematic synergy shifts the center of mass (CM) towards the supporting foot and stabilizes its final position, while the leg movement is being performed. The aim of the present study was to provide insight in the behavioral substitution process responsible for the performance of this kinematic synergy. The kinematic synergy was assessed by the principal component analysis (PCA) applied to both hip joints and supporting ankle joint. Patients after unilateral below-knee amputation and control subjects were asked to perform a lateral leg raising. The first principal component (PC(1)) accounted for more than 99% of the total angular variance for all subjects (amputees and controls). PC(1) thus well represents the possibility to describe this complex multi-joint movement as a one degree of freedom movement with fixed ratios between joint angular time course. In control subjects, the time covariation between joints changes holds during all phases of the leg movement (postural phase, ascending and braking phases). In amputees, PC(1) score decreased during the ascending phase of the movement (i.e. when the body weight transfer is completed, while the movement is initiated). We conclude that a feedback mechanism is involved and discuss the hypothesis that this inter-joint coordination in amputees results from a failure in the pre-setting of the inter-joint coupling.

  20. Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries

    Science.gov (United States)

    Aszmann, Oskar C.; Vujaklija, Ivan; Roche, Aidan D.; Salminger, Stefan; Herceg, Malvina; Sturma, Agnes; Hruby, Laura A.; Pittermann, Anna; Hofer, Christian; Amsuess, Sebastian; Farina, Dario

    2016-01-01

    Critical soft tissue injuries may lead to a non-functional and insensate limb. In these cases standard reconstructive techniques will not suffice to provide a useful outcome, and solutions outside the biological arena must be considered and offered to these patients. We propose a concept which, after all reconstructive options have been exhausted, involves an elective amputation along with a bionic substitution, implementing an actuated prosthetic hand via a structured tech-neuro-rehabilitation program. Here, three patients are presented in whom this concept has been successfully applied after mutilating hand injuries. Clinical tests conducted before, during and after the procedure, evaluating both functional and psychometric parameters, document the benefits of this approach. Additionally, in one of the patients, we show the possibility of implementing a highly functional and natural control of an advanced prosthesis providing both proportional and simultaneous movements of the wrist and hand for completing tasks of daily living with substantially less compensatory movements compared to the traditional systems. It is concluded that the proposed procedure is a viable solution for re-gaining highly functional hand use following critical soft tissue injuries when existing surgical measures fail. Our results are clinically applicable and can be extended to institutions with similar resources. PMID:27721419

  1. 腹腔镜手术治疗残胃癌7例分析%Laparoscopic gastrectomy for gastric stump cancer:analysis of 7 cases

    Institute of Scientific and Technical Information of China (English)

    张人超; 徐晓武; 牟一平; 周育成; 周家瑜; 黄超杰; 许芸芸

    2016-01-01

    目的:探讨腹腔镜手术治疗残胃癌的安全性和可行性。方法回顾性分析2008年1月至2015年7月间在浙江省人民医院胃肠胰外科接受腹腔镜手术治疗的7例残胃癌患者的临床和随访资料。结果7例患者中男性5例,女性2例;年龄(62.1±10.7)岁;胃良性病变术后残胃癌4例,距胃首次手术时间6~30年;胃癌术后残胃再发癌3例,距胃首次手术时间11~15年。首次手术行BillrothⅡ术式者6例,Roux-en-Y术式者1例。本次手术分离腹腔粘连及探查腹腔后确定肿瘤位置后,行残胃切除加淋巴清扫术,然后进行食管空肠Roux-en-Y吻合。1例使用圆形吻合器行食管空肠端侧吻合;2例使用内镜直线切割闭合器食管空肠侧侧吻合;4例行手工缝合食管空肠吻合。手术时间(247.1±17.5) min;术中出血量(100.0±30.8) ml;术中均未输血。淋巴结清扫(19.1±4.8)枚。术后肛门排气时间(3.3±1.5) d;进食流质时间(3.7±0.8) d,住院时间(9.4±2.6) d。1例患者术后出现消化道出血,保守治疗后痊愈;无围手术期死亡者。术后7例均获得随访,随访时间截至2016年1月。随访6~38月。1例术后17月死于腹腔转移,1例术后19月死于阿尔茨海默病。存活的5例至今无肿瘤复发或转移。结论腹腔镜手术治疗残胃癌安全可行。%Objective To evaluate the safety and feasibility of laparoscopic gastrectomy for gastric stump cancer. Methods Clinical and follow-up data of 7 patients who underwent laparoscopic gastrectomy for gastric stump cancer in our department from January 2008 to July 2015 were analyzed retrospectively. Results There were 5 male and 2 female patients, with a mean age of (62.1 ±10.7) years. Initial gastrectomy was performed for gastric cancer in 3 patients and peptic ulceration in 4. The initial surgery was B-Ⅱ gastrojejunostomy in 6 patients and Roux-en-Y gastrojejunostomy in 1

  2. Rebrota de cepas de Acacia mearnsii em diferentes idades, épocas do ano e alturas de corte Resprouting of Acacia mearnsii stumps under different ages, seasons and cut heights

    Directory of Open Access Journals (Sweden)

    Edison Rogério Perrando

    2006-04-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito da idade, da época do ano e da altura de corte sobre a capacidade de rebrota de cepas de Acacia mearnsii De Wild. O trabalho foi conduzido em delineamento de blocos ao acaso e parcelas subdivididas no tempo. Em árvores de quatro e sete anos, foram avaliadas as alturas de corte de 0,15; 0,30; 0,45; 0,60; 1,2 e 2 m aos 15, 30, 45, 60, 75 e 90 dias depois do corte, nas quatro estações do ano. Obteve-se interação significativa entre a altura de corte e a época de avaliação, em ambas as idades avaliadas. As maiores médias, quanto ao número de brotações por cepa, foram constatadas a 1,2 e 2 m de altura, na idade de quatro anos. Elevados porcentuais de mortalidade foram registrados em cepas com sete anos, independentemente da altura de corte. A capacidade de rebrota em cepas de acácia-negra é estimulada, quando o corte é realizado no período entre o outono e a primavera. O verão é a estação menos adequada à rebrota de cepas dessa espécie.The objective of this work was to evaluate the effect of age, time of the year and cut height on the resprouting capacity of Acacia mearnsii De Wild. stumps. The work was conducted in stands of four and seven years of age, in randomized blocks design and time subdivided plots. Different cut heights (0.15; 0.30; 0.45; 0.60; 1.2 and 2 m, and evaluation times (15, 30, 45, 60, 75 and 90 days after cutting, in the four seasons of the year were evaluated. A significant interaction between cut height and evaluation time was found in both ages. The higher averages due to stumps in each strain were verified in 1.2 and 2 m height, in the age of four years. High death percentages were registered in seven years-old stumps, independently of cut height. The resprouting capacity of black wattle stumps is stimulated when cut is conducted between autumn and spring; summer is the least suitable season to stumps resprouting of this specie.

  3. 神经端侧缝合治疗手指顽固性残端痛性神经瘤%Treatment of refractory stump pain caused by neuroma by end-to-side neurorrhaphy

    Institute of Scientific and Technical Information of China (English)

    芮永军; 张志海; 施海峰; 吴权; 柯尊山; 寿奎水

    2011-01-01

    目的 介绍一种治疗顽固性残端痛性神经瘤的手术方法.方法 2006年1月至2010年6月,采用神经端侧缝合的方法治疗手指顽固性残端痛性神经瘤共5例6指,术中彻底切除残端神经瘤直至正常神经组织.其中3例将修整后的神经残端直接与邻指正常指神经作端侧缝合;2例(3指)行腓肠神经移植修复,一端与修整后的神经残端作端端缝合,另一端与邻指指神经作端侧缝合.结果 术后经过12~ 63个月的随访,3例残端神经痛完全消失,2年后未复发;1例随访12个月,疼痛无复发;1例环、小指残端痛,术前已有过4次手术,本次术后环指疼痛消失,小指仍有疼痛,术后1个月小指再次行神经松解,随访63个月小指自发性疼痛减轻,但仍有触痛,环指疼痛消失.参照Burchid的疗效评定标准,优良率为83.3%(5/6).结论 神经端侧缝合的方法可有效治疗残端痛性神经瘤.%Objective To introduce a new method to treat refractory stump pain caused by neuroma.Methods From January 2006 to June 2010,6 fingers in 5 patients with refractory stump pain caused by neuroma were treated by end-to-side neurorrhaphy.The surgical technique included neurolysis,neuroma resection and end-to-side neurorrhaphy.The nerve stump was sutured to the uninjured nerve of the neighboring finger directly in an end-to-side fashion in 3 cases.In the other 3 fingers of 2 cases a sural nerve gnat was used,while one end of the graft was attached to the nerve stump by end-to-end neurorrhaphy and the other end was sutured to the digital nerve of the neighboring finger by end-to-side neurorrhaphy.Results Postoperative follow-up interval ranged from 12 to 63 months.Three patients experienced complete pain relief.There was no recurrence 2 years postoperatively.One patient was follow-up for 12 months when no recurrence of stump pain was observed.Another patient who suffered from stump pain of ring and little fingers experienced full pain relief

  4. Gait biomechanics of individuals with transtibial amputation: effect of suspension system.

    Directory of Open Access Journals (Sweden)

    Arezoo Eshraghi

    Full Text Available Prosthetic suspension system is an important component of lower limb prostheses. Suspension efficiency can be best evaluated during one of the vital activities of daily living, i.e. walking. A new magnetic prosthetic suspension system has been developed, but its effects on gait biomechanics have not been studied. This study aimed to explore the effect of suspension type on kinetic and kinematic gait parameters during level walking with the new suspension system as well as two other commonly used systems (the Seal-In and pin/lock. Thirteen persons with transtibial amputation participated in this study. A Vicon motion system (six cameras, two force platforms was utilized to obtain gait kinetic and kinematic variables, as well as pistoning within the prosthetic socket. The gait deviation index was also calculated based on the kinematic data. The findings indicated significant difference in the pistoning values among the three suspension systems. The Seal-In system resulted in the least pistoning compared with the other two systems. Several kinetic and kinematic variables were also affected by the suspension type. The ground reaction force data showed that lower load was applied to the limb joints with the magnetic suspension system compared with the pin/lock suspension. The gait deviation index showed significant deviation from the normal with all the systems, but the systems did not differ significantly. Main significant effects of the suspension type were seen in the GRF (vertical and fore-aft, knee and ankle angles. The new magnetic suspension system showed comparable effects in the remaining kinetic and kinematic gait parameters to the other studied systems. This study may have implications on the selection of suspension systems for transtibial prostheses. Trial registration: Iranian Registry of Clinical Trials IRCT2013061813706N1.

  5. Asymmetrical loading demands associated with vertical jump landings in people with unilateral transtibial amputation

    Directory of Open Access Journals (Sweden)

    Marlene Schoeman, PhD

    2014-02-01

    Full Text Available Loading symmetry during vertical jump landings between a person with amputation’s intact and prosthetic limbs was assessed to determine the role of each limb in controlling the downward momentum of the center of mass during landing. Six participants with unilateral transtibial amputation (TTA and ten nondisabled participants completed 10 maximal vertical jumps, of which the highest jump was analyzed. Contralateral symmetry was assessed through the Symmetry Index (SI, while symmetry at the group level was assessed through a Mann-Whitney U test. Participants with TTA performed quasi-unilateral landings onto the intact limbs, resulting from either the incapability of the prosthetic ankle to plantar flex or increased residual-limb knee and hip flexion. In the loading phase, the participants with TTA displayed reduced prosthetic-side peak vertical forces (p = 0.04 along with reduced prosthetic-side ankle range of motion (p < 0.001, extensor moments (p = 0.03, and negative work generated (p = 0.00. Individual asymmetries were evident in the peak vertical force magnitudes (SI = 51%–140%, duration from touchdown to peak vertical force (SI = 52%–157%, ankle joint angles at touchdown (SI = 100%–538%, ranges of motion (SI = 147%–200%, knee (SI = 66%–179% and hip (SI = 87%–132% extensor moments, and work done at the ankle (SI = 155%–199% and hip (SI = 83%–204%. High peak forces (25.25 +/– 4.89 N·kg−1 intact limb and 14.61 +/– 8.28 N·kg−1 prosthetic limb from significantly lower (p < 0.001 landing heights than the nondisabled participants indicate a potential injury risk associated with landing for people with TTA.

  6. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Serkan DİKİCİ

    2015-01-01

    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  7. Biomechanics of the human walk-to-run gait transition in persons with unilateral transtibial amputation.

    Science.gov (United States)

    Giest, Tracy N; Chang, Young-Hui

    2016-06-14

    Propulsive force production (indicative of intrinsic force-length-velocity characteristics of the plantar flexor muscles) has been shown to be a major determinant of the human walk-to-run transition. The purpose of this work was to determine the gait transition speed of persons with unilateral transtibial amputation donning a passive-elastic prosthesis and assess whether a mechanical limit of their intact side plantar flexor muscles is a major determinant of their walk-to-run transition. We determined each individual׳s gait transition speed (GTS) via an incremental protocol and assessed kinetics and kinematics during walking at speeds 50%, 60%, 70%, 80%, 90%, 100%, 120%, and 130% of that gait transition speed (100%:GTS). Unilateral transtibial amputees transitioned between gaits at significantly slower absolute speeds than matched able-bodied controls (1.73±0.13 and 2.09±0.05m/s respectively, p120%: 0.23±0.05BW, p<0.05). In contrast, amputee subjects' intact side generated significantly higher peak anterior-posterior propulsive forces while walking at speeds above their preferred gait transition speed (100%: 0.28±0.04<110%: 0.30±0.04BW, p<0.05). Changes in propulsive force production were found to be a function of changes in absolute speed, rather than relative to the walk-to-run transition speed. Therefore, the walk-to-run transition in unilateral transtibial amputees is not likely dictated by propulsive force production or the force-length-velocity characteristics of the intact side plantar flexor muscles. PMID:27087677

  8. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    Directory of Open Access Journals (Sweden)

    Jun Yao

    2015-01-01

    Full Text Available This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR. As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via the newly re-innervated muscles. Correspondingly, recent study results have shown that motor representations for the missing limb move closer to their original locations following TR. Besides regaining motor control signals, TR also restores the sensation in the re-innervated skin areas. We therefore hypothesize that TR causes analogous cortical sensory remapping that may return closer to their original locations. In order to test this hypothesis, cortical activity in response to sensory-level electrical stimulation in different parts of the arm was studied longitudinally in one amputated individual before and up to 2 years after TR. Our results showed that 1 before TR, the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain; and 2 2 years after TR, the sensory map of the reinnervated median nerve reorganized, showing predominant activity over the contralateral S1 hand area as well as moderate activity over the ipsilateral S1. Therefore, this work provides new evidence for long-term sensory cortical plasticity in the human brain after TR.

  9. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb.

  10. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb. PMID:26854561

  11. Penis auto-amputation and chasm of the lower abdominal wall due to advanced penile carcinoma: a case report

    OpenAIRE

    Baltogiannis Dimitrios; Zotos Konstantinos; Tsambalas Stavros; Giannakis Dimitrios; Sofikitis Nikolaos

    2011-01-01

    Abstract Introduction Penile cancer is uncommon. When penile cancer is left untreated, at an advanced stage it can have tragic consequences for the patient. Case presentation Our case report does not concern a new manifestation of penile cancer, but an interesting presentation with clinical significance that emphasizes the need to diagnose and treat penile cancer early. It is an unusual case of a neglected penile cancer in a 57-year-old Greek man that led to auto-amputation of the penis and a...

  12. Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Nielsen, Anni Østergaard; Madsen Topp, Ulla;

    2014-01-01

    Balance is beneficial for daily functioning of patients with a lower limb amputation and sometimes assessed by the one-leg stand test (OLST). The aims of the study were to examine (1) the number of trials needed to achieve performance stability, (2) the interrater reliability of the OLST in patie......Balance is beneficial for daily functioning of patients with a lower limb amputation and sometimes assessed by the one-leg stand test (OLST). The aims of the study were to examine (1) the number of trials needed to achieve performance stability, (2) the interrater reliability of the OLST...... in patients with a major non-traumatic lower limb amputation, and (3) to provide a test procedure....

  13. Risk factors of amputation in patients with diabetic foot ulcer%糖尿病足患者截肢的相关危险因素

    Institute of Scientific and Technical Information of China (English)

    肖婷; 许樟荣

    2010-01-01

    Diabetic foot is one of the serious complications of diabetes mellitus and the main cause of non-traumatic amputation. Neuropathy,ischemia,infection,malnutrition,smoking and other factors are associated with the diabetic amputation. To control these risk factors can reduce the prevalence of diabetic foot ulcers and diabetic amputation.%糖尿病足足糖尿病的严重并发症之一,是非创伤件截肢的主要原因.神经病变、缺血、感染、营养不良、吸烟等多种因素与糖尿病足溃疡截肢有关.控制上述危险因素,可以降低糖尿病足溃疡的发病率和截肢率.

  14. Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers

    DEFF Research Database (Denmark)

    Siersma, V.; Thorsen, H.; Holstein, P.E.;

    2014-01-01

    ObjectiveLow health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers has prognostic significance for ulcer...... healing, major amputation and death.Research design and methodsWe followed 1088 patients with new diabetic foot ulcers presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale study, prospectively until healing (76.9%), major amputation (4.6%) or death (6...

  15. A Simple Technique for the Positioning of a Patient with an above Knee Amputation for an Ipsilateral Extracapsular Hip Fracture Fixation

    Directory of Open Access Journals (Sweden)

    N. Davarinos

    2013-01-01

    Full Text Available The positioning of the patient on the fracture table is critical to the successful reduction and operative fixation of hip fractures which are fixed using the dynamic hip screw system (DHS. There is a standard setup which is commonly used with relative ease. Yet the positioning of patients with amputations either above or below knee of the affected side can pose a significant challenge. We describe a novel positioning technique used on a 51-year old patient with a right above knee amputation who sustained an intertrochanteric extracapsular hip fracture.

  16. Effect of amputation level on the stress transferred to the femur by an artificial limb directly attached to the bone.

    Science.gov (United States)

    Newcombe, L; Dewar, M; Blunn, G W; Fromme, P

    2013-12-01

    Attachment of an artificial limb directly to the skeleton has a number of potential benefits and the technique has been implemented for several amputation sites. In this paper the transfer of stress from an external, transfemoral prosthesis to the femur during normal walking activity is investigated. The stress distribution in the femur and at the implant-bone interface is calculated using finite element analysis for the 3D geometry and inhomogeneous, anisotropic material properties obtained from a CT scan of a healthy femur. Attachment of the prosthetic leg at three different levels of amputation is considered. Stress concentrations are found at the distal end of the bone and adjacent to the implant tip and stress shielding is observed adjacent to the implant. It is found that the stress distribution in the femur distal to the epiphysis, where the femur geometry is close to cylindrical, can be predicted from a cylindrical finite element model, using the correct choice of bone diameter as measured from a radiograph. Proximal to the lesser trochanter the stress decreases as the femur geometry diverges significantly from a cylinder. The stress concentration at the distal, resected end of the bone is removed when a collared implant is employed. These findings form the basis for appropriate settings of an external fail-safe device to protect the bone from excessive stress in the event of an undue load. PMID:23953406

  17. Breathing-controlled electrical stimulation could modify the affective component of neuropathic pain after amputation: a case report

    Directory of Open Access Journals (Sweden)

    Melton DH

    2012-04-01

    Full Text Available Sheng Li1,2, Danielle H Melton1, Jeffrey C Berliner11Department of Physical Medicine and Rehabilitation, University of Texas Medical School – Houston, Houston, TX; 2UTHealth Motor Recovery Laboratory, Institute for Rehabilitation and Research, Memorial Hermann Hospital, Houston, TX, USAAbstract: In this case, a 31-year-old male suffered phantom neuropathic pain for more than 3 years after an above-the-knee amputation. His shooting phantom pain disappeared after the first session of breathing-controlled electrical stimulation, and reappeared or was triggered 28 days after an experimental error during which he received sustained electrical stimulation. In other words, painful shooting stimuli may not have been “cured” but forgotten and retriggered by a fearful event due to the experimental error. Therefore, this accidental finding provides a unique opportunity to understand sensory and affective components of neuropathic pain, and a novel intervention could modify the affective component of it.Keywords: neuropathic pain, amputation, electrical stimulation, voluntary breathing

  18. Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days.

    Science.gov (United States)

    Armstrong, David G; Salas, Precious; Short, Brian; Martin, Billy R; Kimbriel, Heather R; Nixon, Brent P; Boulton, Andrew J M

    2005-01-01

    We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean +/- SD age, 72.2 +/- 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 +/- 4.8 versus 22.4 +/- 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 +/- 30.3 versus 81.9 +/- 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds.

  19. Effect of amputation level on the stress transferred to the femur by an artificial limb directly attached to the bone.

    Science.gov (United States)

    Newcombe, L; Dewar, M; Blunn, G W; Fromme, P

    2013-12-01

    Attachment of an artificial limb directly to the skeleton has a number of potential benefits and the technique has been implemented for several amputation sites. In this paper the transfer of stress from an external, transfemoral prosthesis to the femur during normal walking activity is investigated. The stress distribution in the femur and at the implant-bone interface is calculated using finite element analysis for the 3D geometry and inhomogeneous, anisotropic material properties obtained from a CT scan of a healthy femur. Attachment of the prosthetic leg at three different levels of amputation is considered. Stress concentrations are found at the distal end of the bone and adjacent to the implant tip and stress shielding is observed adjacent to the implant. It is found that the stress distribution in the femur distal to the epiphysis, where the femur geometry is close to cylindrical, can be predicted from a cylindrical finite element model, using the correct choice of bone diameter as measured from a radiograph. Proximal to the lesser trochanter the stress decreases as the femur geometry diverges significantly from a cylinder. The stress concentration at the distal, resected end of the bone is removed when a collared implant is employed. These findings form the basis for appropriate settings of an external fail-safe device to protect the bone from excessive stress in the event of an undue load.

  20. Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Hemakumar Devan, MPhty

    2013-01-01

    Full Text Available Lower-back pain (LBP is a common secondary condition following lower-limb amputation. The purpose of this study was to investigate LBP prevalence and the relationship between LBP and physical activity (PA levels in a national sample of persons with traumatic transfemoral amputation (TFA. Questionnaires were mailed to a random sample of people with traumatic TFA (n = 322 from the New Zealand Artificial Limb Board national database. Of the participants who completed the survey (55% response rate, 64.1% reported LBP and 39.1% reported restricted PA due to LBP. There was no relationship between the PA levels of persons with and without LBP (chi-square = 2.11, p > 0.05. There was an equal distribution of persons with LBP in low, medium, and high PA subgroups. However, persons who reported restricted PA due to LBP had lower PA scores than persons with LBP and no restricted PA (chi-square = 11.56, p < 0.05. Based on our results, LBP is prevalent in the traumatic TFA population. PA levels are not influenced by the presence or absence of LBP. However, future studies investigating LBP coping strategies and using objective PA outcome measures might further elucidate the relationship between PA and LBP in this population.

  1. 足部恶性软组织肿瘤患者的特殊类型截肢二例报告%Special types of amputation in patients with foot malignant soft tissue tumors:2 cases report

    Institute of Scientific and Technical Information of China (English)

    杨接来; 张智长; 潘垚; 杨庆诚

    2015-01-01

    Objective To report 2 cases of special types of amputation in patients with foot malignant soft tissue tumors.Methods From January 2008 to December 2012, 2 cases of special types of amputation in patients with foot malignant soft tissue tumors were conducted. Case 1 of rhabdomyosarcoma in the right forefoot was performed with Chopart amputation. Case 2 of squamous cell carcinoma of the right plantar was performed with Syme amputation.Results Two surgeries went successfully. Case 1 was followed up for 23 months. Case 2 was followed up for 22 months. No recurrence occurred after the surgery. Patients could walk well by prosthesis, with good recovery of lower limb functions and no significant adverse complications.Conclusions In the premise of extensive tumor resection, Chopart and Syme amputation are good options in the treatment of foot malignant soft tissue tumors, which can preserve the limb length and functions to the greatest degree and further improve the life quality of patients.

  2. Sexual functioning and sexual well-being in people with a limb amputation : a cross-sectional study in the Netherlands

    NARCIS (Netherlands)

    Verschuren, Jesse E A; Geertzen, Jan H.; Enzlin, Paul; Dijkstra, Pieter U; Dekker, Rienk

    2015-01-01

    PURPOSE: This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process. METHOD: In total,

  3. Sexual functioning and sexual well-being in people with a limb amputation : a cross-sectional study in the Netherlands

    NARCIS (Netherlands)

    Verschuren, Jesse E. A.; Geertzen, Jan H.; Enzlin, Paul; Dijkstra, Pieter U.; Dekker, Rienk

    2016-01-01

    Purpose: This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process. Method: In total,

  4. How Depressive Levels Are Related to the Adults' Experiences of Lower-Limb Amputation: A Mixed Methods Pilot Study

    Science.gov (United States)

    Senra, Hugo

    2013-01-01

    The current pilot study aims to explore whether different adults' experiences of lower-limb amputation could be associated with different levels of depression. To achieve these study objectives, a convergent parallel mixed methods design was used in a convenience sample of 42 adult amputees (mean age of 61 years; SD = 13.5). All of them had…

  5. Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation

    NARCIS (Netherlands)

    Theeven, P.J.; Hemmen, B.; Geers, R.P.; Smeets, R.J.P.; Brink, P.R.; Seelen, H.A.

    2012-01-01

    OBJECTIVE: To assess the effects of two types of microprocessor-controlled prosthetic knee joints (MPKs) on perceived performance and everyday life activity level. DESIGN: Randomized cross-over trial. SUBJECTS: Thirty persons with a unilateral above-knee amputation or knee disarticulation classified

  6. The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System

    OpenAIRE

    Stineman, Margaret G.; Kwong, Pui L.; Kurichi, Jibby E.; Prvu-Bettger, Janet A.; Vogel, W. Bruce; Maislin, Greg; Bates, Barbara E.; Reker, Dean M.

    2008-01-01

    Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil 2008;89:1863-72.

  7. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

    Directory of Open Access Journals (Sweden)

    Tjokorda Gde Dalem Pemayun

    2015-12-01

    Full Text Available Background: Diabetic foot ulcers (DFU may cause significant morbidity and lower extremity amputation (LEA due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods: We performed a hospital-based, case–control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years, sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs and 95% confidence intervals (CIs by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21. Results: There were 47 case–control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12–134.31; p=0.002, presence of peripheral arterial disease (PAD (OR 12.97, 95% CI 3.44–48.88; p<0.001, hypertriglyceridemia (OR 5.58, 95% CI 1.74–17.91; p=0.004, and hypertension (OR 3.67, 95% CI 1.14–11.79; p=0.028 as the independent risk factors associated with subsequent LEA in DFU. Conclusions: Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study

  8. A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas

    Directory of Open Access Journals (Sweden)

    Kuiken Todd A

    2011-10-01

    Full Text Available Abstract Background Surgical treatment of neuromas involves excision of neuromas proximally to the level of grossly "normal" fascicles; however, proximal changes at the axonal level may have both functional and therapeutic implications with regard to amputated nerves. In order to better understand the retrograde "zone of injury" that occurs after nerve transection, we investigated the gross and histologic changes in transected nerves using a rabbit forelimb amputation model. Methods Four New Zealand White rabbits underwent a forelimb amputation with transection and preservation of the median, radial, and ulnar nerves. After 8 weeks, serial sections of the amputated nerves were then obtained in a distal-to-proximal direction toward the brachial plexus. Quantitative histomorphometric analysis was performed on all nerve specimens. Results All nerves demonstrated statistically significant increases in nerve cross-sectional area between treatment and control limbs at the distal nerve end, but these differences were not observed 10 mm more proximal to the neuroma bulb. At the axonal level, an increased number of myelinated fibers were seen at the distal end of all amputated nerves. The number of myelinated fibers progressively decreased in proximal sections, normalizing at 15 mm proximally, or the level of the brachial plexus. The cross-sectional area of myelinated fibers was significantly decreased in all sections of the treatment nerves, indicating that atrophic axonal changes proceed proximally at least to the level of the brachial plexus. Conclusions Morphologic changes at the axonal level extend beyond the region of gross neuroma formation in a distal-to-proximal fashion after nerve transection. This discrepancy between gross and histologic neuromas signifies the need for improved standardization among neuroma models, while also providing a fresh perspective on how we should view neuromas during peripheral nerve surgery.

  9. Secondary Knee Osteoarthritis due to Neurofibromatosis Type 1 Treated with above the Knee Amputation: A Case Report

    Directory of Open Access Journals (Sweden)

    Jay Patel

    2013-01-01

    Full Text Available Background. Neurofibromatosis Type 1 (NF-1 has a variety of associated orthopaedic manifestations that have been previously reported. We report a case of severe, grade 4 knee osteoarthritis (OA with recurrent subluxation and joint laxity due to multiple extra-articular neurofibromas ultimately treated with Above the Knee Amputation (AKA. Case Description. A 39-year-old man presented with multiple neurofibromas and lymphedema leading to degenerative changes of the knee. Conservative treatment failed due to the severity of the knee degeneration and patient discomfort. Likewise, arthroplasty was not possible due to poor bone quality and joint instability. Therefore, AKA was selected to relieve symptoms and provide functional improvement. six months after the procedure the patient has increased functional capacity for ambulation and activities of daily living, as well as significant decrease in pain and discomfort. Clinical Relevance. Extra-articular neurofibromas causing severe secondary OA in relatively young patients can be functionally improved with AKA and prosthetic device use.

  10. Penis auto-amputation and chasm of the lower abdominal wall due to advanced penile carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Baltogiannis Dimitrios

    2011-12-01

    Full Text Available Abstract Introduction Penile cancer is uncommon. When penile cancer is left untreated, at an advanced stage it can have tragic consequences for the patient. Case presentation Our case report does not concern a new manifestation of penile cancer, but an interesting presentation with clinical significance that emphasizes the need to diagnose and treat penile cancer early. It is an unusual case of a neglected penile cancer in a 57-year-old Greek man that led to auto-amputation of the penis and a large chasm in the lower abdominal wall. The clinical staging was T4N3M0 and our patient was treated with a bilateral cutaneous ureterostomy, chemotherapy and radiotherapy. Our patient died 18 months after his first admission in our clinic. Conclusions Emphasis must be placed on early diagnosis and treatment of penile cancer, so further development of the disease can be prevented.

  11. 不同生境下栓皮栎伐桩萌苗的生长特征及在种群更新中的作用%Features of Quercus variabilis Stump Sprouting and Its Contribution to Population Regeneration in Different Habitats

    Institute of Scientific and Technical Information of China (English)

    薛瑶芹; 张文辉; 马莉薇; 马闯; 周建云

    2012-01-01

    Quercus variabilis is an important constructive species in the warm temperate and the subtropical forests in China, and it is also a resource tree for tannin and cork. Most of natural Q. variabilis forests in China have degenerated to secondary forests after long time overexploitation. Lack of regeneration resource as well as low productivity is among the worst problems for the forests. Therefore, it is crucial to clearly understand how to promote population and forest regeneration to recover the secondary forests. Stump sprouting is an important type of vegetative regeneration of Q. variabilis. In order to understand the role of stump sprouts in population regeneration in different habitats, 25 plots, distributed in forest gap, forest edge and understory of Louguantai, Zhouzhi county, Shaanxi Province, were set to investigate the influence of different environment conditions on the sprouting ability, survival rate and growth features in July 2009. The results showed; 1) There were three kinds of regeneration recruits in the research area, named as seedlings, stump sprouts and stem sprouts, among which stump sprouts were the main asexual recruits. 2) Stump sprouting contributed differently to the population regeneration in different habitats. In forest understory, both stump sprouts and seedlings were dominant regeneration recruits, while in forest gap and forest edge, stump sprouts were the most dominant recruits. 3) Habitats conditions, especially the illumination, affected stump sprouting ability, survival rate and growth characteristics of stump sprouts. Stumps in forest gaps had greater sprouting ability, however the sprouts had greater dead rate compared with those in forest understory and forest edge. The sprouting seedlings, in terms of base diameter, height, leaf area and aboveground biomass, grew best. 4) Forest gaps were a friendly habitat which was beneficial for stump sprouting and sprouting seedlings growth compared with forest understory and forest

  12. The vaginal stump cytology role in follow-up after treatment of cervical cancer%阴道残端超薄细胞学检查在宫颈癌治疗后随访中的作用

    Institute of Scientific and Technical Information of China (English)

    刘春红; 殷超

    2015-01-01

    Objective To assess the clinical role of vaginal stump cytology in follow-up of cervical cancer patients who had surgery treatment. Method A retrospective analysis of these patients underwent cervical cancer surgery in our hospital between January 1, 2002 and December 31, 2005, and the data of the vaginal stump ultra-thin cytology about these patients were intact during postoperative follow-up. Result Totally, 1244 cases of cervical vaginal exam-inations from 300 female patients were involved in our research. Abnormalities in the vaginal cytology stump exami-nation was showed by 187 cases from 93 patients, which including 83 cases of atypical squamous cells without defi-nitely diagnostic significance, 58 cases of low-grade squamous intraepithelial lesions, 34 cases of highly squamous intraepithelial lesion , 6 cases of atypical glandular cell lesions,6 patients of tumor tendency. 25 patients had CINⅡ or worse lesions were showed in colposcopy examination of these abnormal cases. No recurrence or CINⅢof col-poscopy biopsy was not found in these patients which was also better vaginal stump cytological results than HSIL. Conclusion During follow-up, 1/3 cervical cancer survivors may have abnormal cytology; cytological results for HSIL patients should accept the colposcopy. If there is no visible lesions, ASC-US or LSIL patients cannot to col-poscopy in follow up, unless the abnormalities persist.%目的:评估阴道残端细胞学在宫颈癌随访中的作用。方法回顾分析2002年1月至2005年12月在本院因宫颈癌行手术治疗的患者,对300例患者的1244个阴道残端细胞学结果进行分析。结果93例患者的187个细胞学结果异常,包括83个诊断意义尚不明确的非典型鳞状上皮改变( atypical squamous cell of undetermined significance,ASC-US),58个低度鳞状上皮内病变(low grade squamous intraepithelial le-sion,LSIL),34个高度鳞状上皮内病变( high grade squamous intraepithelial lesion,HSIL),6

  13. 糖尿病足截肢的相关危险因素分析%Analysis of the Related Risk Factors of Diabetic Foot Amputation

    Institute of Scientific and Technical Information of China (English)

    陈茂胜

    2013-01-01

    [目的]探讨糖尿病足截肢的相关危险因素,以降低糖尿病足的截肢率。[方法]回顾性分析2006年3月至2012年3月在本院接受治疗的121例糖尿病足患者的临床资料,比较截肢(截肢组)与未截肢(未截肢组)患者的临床资料及生化指标。[结果]两组患者年龄、病程、吸烟史、高血压史、空腹血糖(FBG)及糖化血红蛋白(HbAlc)水平方面比较差异有显著性(P <0.05),但在性别、血脂及糖尿病肾病(DN)的发生率比较无显著差异(P >0.05);糖尿病足截肢率与糖尿病足分级程度、下肢动脉病变程度及周围神经损伤程度呈正相关。[结论]患者病程、年龄、吸烟、血压、血糖、下肢血管病变程度、神经病变程度及糖尿病足程度均为糖尿病足截肢的高危因素,临床可根据患者情况,采取积极措施,减少截肢率,提高患者生活质量。%[Objective]To explore the related risk factors of diabetic foot amputation in order to reduce the amputation rate of diabetic foot.[Methods]Clinical data of 121 patients with diabetic foot who were treated in our hospital from March 2006 to March 2012 were analyzed retrospectively.Clinical data and biochemical inde-xes were compared between amputation group and non-amputation group.[Results]There were significant differences in the age,the course of disease,smoking history,hypertension history,fasting blood glucose (FBG)and glycosylated hemoglobin(HbAlc)level between two groups(P 0.05). The amputation rate of diabetic foot amputation rate had positive correlation with the grade of diabetic foot, the degree of lower limb artery lesion and peripheral nerve injury.[Conclusion]The patients'course of dis-ease,age,smoking,blood pressure,blood sugar,the degree of lower extremity vascular lesion,neuropathy and diabetic foot were high-risk factors of diabetic foot amputation.According to patients'condition in clinical practice

  14. Impact of deteriorated calcium-phosphate homeostasis on amputation-free survival after endovascular revascularization in patients with critical limb ischemia on hemodialysis.

    Science.gov (United States)

    Hioki, Hirofumi; Miyashita, Yusuke; Shiraki, Tatsuya; Iida, Osamu; Uematsu, Masaaki; Miura, Takashi; Ebisawa, Souichirou; Ikeda, Uichi

    2016-04-01

    Patients on hemodialysis (HD) have abnormalities of calcium-phosphate (CaP) homeostasis and high CaP product contributes to atherosclerosis pathogenesis and adverse events. Patients on HD with critical limb ischemia (CLI) are at risk for major amputation and death because of advanced systemic atherosclerotic disease. The aim of this study was to evaluate the relationship between CaP product and amputation-free survival (AFS) in CLI after endovascular treatment (EVT). We retrospectively analyzed 221 CLI patients on HD. In Kaplan-Meier analysis, AFS was significantly lower in patients with CaP product ⩾ 55 mg(2)/dL(2) compared to those with CaP product EVT in CLI patients on HD, and can serve for their risk stratification. PMID:26681436

  15. 3D nuclear organization of telomeres in the Hodgkin cell lines U-HO1 and U-HO1-PTPN1: PTPN1 expression prevents the formation of very short telomeres including "t-stumps"

    Directory of Open Access Journals (Sweden)

    Lemieux Bruno

    2010-12-01

    Full Text Available Abstract Background In cancer cells the three-dimensional (3D telomere organization of interphase nuclei into a telomeric disk is heavily distorted and aggregates are found. In Hodgkin's lymphoma quantitative FISH (3D Q-FISH reveals a major impact of nuclear telomere dynamics during the transition form mononuclear Hodgkin (H to diagnostic multinuclear Reed-Sternberg (RS cells. In vitro and in vivo formation of RS-cells is associated with the increase of very short telomeres including "t-stumps", telomere loss, telomeric aggregate formation and the generation of "ghost nuclei". Results Here we analyze the 3D telomere dynamics by Q-FISH in the novel Hodgkin cell line U-HO1 and its non-receptor protein-tyrosine phosphatase N1 (PTPN1 stable transfectant U-HO1-PTPN1, derived from a primary refractory Hodgkin's lymphoma. Both cell lines show equally high telomerase activity but U-HO1-PTPN differs from U-HO1 by a three times longer doubling time, low STAT5A expression, accumulation of RS-cells (p As expected, multinuclear U-HO1-RS-cells and multinuclear U-HO1-PTPN1-RS-cells differ from their mononuclear H-precursors by their nuclear volume (p Conclusion Abundant RS-cells without additional very short telomeres including "t-stumps", high rate of apoptosis, but low STAT5A expression, are hallmarks of the U-HO1-PTPN1 cell line. These characteristics are independent of telomerase activity. Thus, PTPN1 induced dephosphorylation of STAT5 with consecutive lack of Akt/PKB activation and cellular arrest in G2, promoting induction of apoptosis, appears as a possible pathogenetic mechanism deserving further experimental investigation.

  16. Effect of Roy’s Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial

    Science.gov (United States)

    Farsi, Zahra; Azarmi, Somayeh

    2016-01-01

    Background: Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy’s adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. Methods: In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy’s adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. Results: Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). Conclusion: The findings of this research indicated that the Roy’s adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy’s adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. Trial Registration Number: IRCT2014081118763N1 PMID:27218110

  17. Auto-amputation of penis due to carcinoma: Still a threat in the era of modern medicine: Report of two cases

    OpenAIRE

    Bastab Ghosh; Ramanitharan Manikandan; Dorairajan, Lalgudi N.; Santosh Kumar

    2013-01-01

    Incidence of penile carcinoma is decreasing worldwide. Nevertheless, the incidence of penile cancer is still significant in various tropical countries, and it often presents in advanced stage. We report two unique cases of penile auto-amputation due to advanced cancer and review relevant literature. Both the patients presented with ulcerative lesion replacing penile base following automatic sloughing of the whole penis and voiding dysfunction. In addition, the first patient had metastatic ing...

  18. 高压氧在断指再植术后的临床应用%Clinical Application of Hyperbaric Oxygen Therapy after Replantation of Amputated Finger

    Institute of Scientific and Technical Information of China (English)

    韩扬; 谢荭

    2011-01-01

    Postoperative management of replantation of amputated finger is of vital importance. Active and reasonable hyperbaric oxygen therapy can promote microcirculation rebuild and functional recovery after operation, shorten the rehabilitation time, further reduce the risk of amputated finger deactivation by increasing the oxygen pressure, oxygen concentration in amputated finger and operative region rapidly, improve hypoxia state of tissue effectively, reduce capillary permeability and lessen swelling. Hyperbaric oxygen therapy can be applied as one of the routine therapeutic measures after replantation operation of amputated finger,especially in multi-finger replantation and multi-segment one-finger replantation,where hyperbaric oxygen therapy should be used more actively.%断指再植的术后处理至关重要.积极、合理的高压氧治疗能通过迅速提高断指及手术区域的氧分压、氧含量,有效改善组织缺氧状态和降低毛细血管通透性从而减轻伤指肿胀等机制,促进断指术后的微循环重建和功能恢复,缩短康复时程,进一步降低断指失活风险.高压氧治疗应作为断指再植手术后的常规治疗措施之一.尤其是多指离断再植及一指多段离断再植高压氧治疗应更加积极地予以应用.

  19. Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.

    Science.gov (United States)

    Dellon, A Lee; Muse, Vickie L; Nickerson, D Scott; Akre, Thomas; Anderson, Sharon R; Barrett, Steve L; Biddinger, Kent R; Bregman, Peter J; Bullard, Bryan P; Dauphinee, Damien M; DeJesus, James M; DeJesus, Ramon A; Ducic, Ivica; Dunkerly, Jeffery; Galina, Michael R; Hung, Virginia; Ichtertz, Dolf R; Kutka, Michael F; Jacoby, Richard P; Johnson, J Barry; Mader, David W; Maloney, Christopher T; Mancuso, Peter J; Martin, R Craig; Martin, Rick F; McDowel, Brian A; Rizzo, Vito J; Rose, Michael; Rosson, Gedge D; Shafiroff, Bruce B; Steck, Jerome K; Stolarski, Raymond G; Swier, Patrick; Wellens-Bruschayt, Tatiana A; Wilke, Bronwyn; Williams, Eric H; Wood, Michael A; Wood, William A; Younes, Michael P; Yuksel, Fuat

    2012-05-01

    This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection. PMID:22411624

  20. Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID.

    Science.gov (United States)

    Bottini, Gabriella; Brugger, Peter; Sedda, Anna

    2015-01-01

    Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric disorders, and a psychiatric etiology is still a valid alternative to purely neurological accounts of BIID. In this study, we explored, by means of a computerized experiment, facial emotion recognition and emotional responses to disgusting images in seven individuals with BIID, taking into account their clinical features and investigating in detail disgust processing, strongly linked to insular functioning. We demonstrate that BIID is not characterized by a general emotional impairment; rather, there is a selectively reduced disgust response to violations of the body envelope. Taken together, our results support the need to explore this condition under an interdisciplinary perspective, taking into account also emotional connotations and the social modulation of body representation. PMID:24679146

  1. Factors Affecting Length of Hospital Stay and Mortality in Infected Diabetic Foot Ulcers Undergoing Surgical Drainage without Major Amputation.

    Science.gov (United States)

    Kim, Tae Gyun; Moon, Sang Young; Park, Moon Seok; Kwon, Soon-Sun; Jung, Ki Jin; Lee, Taeseung; Kim, Baek Kyu; Yoon, Chan; Lee, Kyoung Min

    2016-01-01

    This study aimed to investigate factors affecting length of hospital stay and mortality of a specific group of patients with infected diabetic foot ulcer who underwent surgical drainage without major amputation, which is frequently encountered by orthopedic surgeons. Data on length of hospital stay, mortality, demographics, and other medical information were collected for 79 consecutive patients (60 men, 19 women; mean age, 66.1 [SD, 12.3] yr) with infected diabetic foot ulcer who underwent surgical drainage while retaining the heel between October 2003 and May 2013. Multiple linear regression analysis was performed to determine factors affecting length of hospital stay, while multiple Cox regression analysis was conducted to assess factors contributing to mortality. Erythrocyte sedimentation rate (ESR, P=0.034), glycated hemoglobin (HbA1c) level (P=0.021), body mass index (BMI, P=0.001), and major vascular disease (cerebrovascular accident or coronary artery disease, P=0.004) were significant factors affecting length of hospital stay, whereas age (P=0.005) and serum blood urea nitrogen (BUN) level (P=0.024) were significant factors contributing to mortality. In conclusion, as prognostic factors, the length of hospital stay was affected by the severity of inflammation, the recent control of blood glucose level, BMI, and major vascular disease, whereas patient mortality was affected by age and renal function in patients with infected diabetic foot ulcer undergoing surgical drainage and antibiotic treatment.

  2. The Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics During Walking in Persons with Bilateral Transtibial Amputations

    Science.gov (United States)

    Gard, Steven A.; Su, Po-Fu; Lipschutz, Robert D.; Hansen, Andrew H.

    2015-01-01

    Some important functions of walking are adversely affected or eliminated in prosthesis users due to reduced or absent ankle motion. The purpose of this retrospective data analysis was to determine the effect of prosthetic ankle units on the characteristics of the ankle-foot roll-over shape in persons with bilateral transtibial amputations. Seventeen subjects were fitted with Endolite Multiflex Ankles to provide ankle plantar/dorsiflexion during the stance phase of gait. Two quantitative gait analyses were performed as subjects walked with (1) Seattle Lightfoot II feet (baseline condition) and (2) with the prosthetic ankle units added. Roll-over shape radii and effective foot length ratio were calculated and compared for the two prosthetic configurations. When subjects walked with the ankle units, ankle motion increased (p<0.001), peak ankle plantarflexion moment during stance decreased slightly, and ankle-foot roll-over shape radii were significantly less (p<0.001) compared to the baseline condition. The effective foot length ratio of the roll-over shape was found to increase with walking speed (p<0.001), but it was not significantly affected by the prosthetic ankle units (p=0.066). Prosthetists and manufacturers are encouraged to consider the effect of combining prosthetic components on the overall characteristics of the prosthesis and the functions they impart to the user. PMID:22234709

  3. Prosthetic interventions for people with transtibial amputation: Systematic review and metaanalysis of high-quality prospective literature and systematic reviews

    Directory of Open Access Journals (Sweden)

    M. Jason Highsmith, PhD, DPT, CP, FAAOP

    2016-03-01

    Full Text Available Considering transtibial amputation (TTA rehabilitation costs and complexity, high-quality literature should inform clinical practice. Systematic reviews (SRs suggest this is not the case. This article's purpose was to review the highest-quality evidence available to guide clinical practice for TTA regarding five prosthetic intervention areas. Six databases were searched for high-quality SRs and prospective clinical trials (randomized clinical trials [RCTs]. Reviewers screened, sorted, rated (i.e., methodologic quality, bias risk, and extracted article data. Meta-analyses were conducted when possible. Thirty-one references were included (25 RCTs and 6 SRs. Five topical areas emerged (alignment, feet and ankles, interface, postoperative care, pylons. Twenty-three evidence statements were supported by level 2 evidence and eight by level 1 evidence. All RCTs reported randomization and reasonable data presentation. Concealed allocation and blinding were not widely used. Mean attrition was 11%. SRs included no meta-analyses. Functional level was poorly reported. Grouping feet and ankle components by functional classification enabled meta-analyses, though variance was considerable given the small sample sizes. Prosthetic interventions are generally safe for TTAs. High-quality literature enabled formulation of evidence statements to support select clinical practice areas, though quantity was lacking. Thus, numerous topics related to TTA care lack rigorous evidence. Although blinding in prosthetic research requires increased funding and effort, it could greatly improve the methodologic quality of prosthetic research.

  4. Parametric analysis using the finite element method to investigate prosthetic interface stresses for persons with trans-tibial amputation.

    Science.gov (United States)

    Silver-Thorn, M B; Childress, D S

    1996-07-01

    A finite element (FE) model of the below-knee residual limb and prosthetic socket was created to investigate the effects of parameter variations on the interface stress distribution during static stance. This model was based upon geometric approximations of anthropometric residual limb geometry. The model was not specific to an individual with amputation, but could be scaled to approximate the limb of a particular subject. Parametric analyses were conducted to investigate the effects of prosthetic socket design and residual limb geometry on the residual limb/prosthetic socket interface stresses. Behavioral trends were illustrated via sensitivity analysis. The results of the parametric analyses indicate that the residual limb/prosthetic socket interface stresses are affected by variations in both prosthetic design and residual limb geometry. Specifically, the analyses indicate: 1) the residual limb/prosthetic liner interface pressures are relatively insensitive to the socket stiffness; 2) the stiffness of the prosthetic liner influences the interface stress distribution for both the unrectified and patellar-tendon-bearing (PTB) rectified models-the external load state appears to influence the interface pressure distribution, while the prosthetic socket rectification appears to influence the interface shear stress distribution; 3) the interface pressures are very sensitive to the prosthetic rectification; 4) the shape and relative bulk of soft tissue may significantly influence the interface pressure distribution; 5) the interface pressure distribution is also influenced by the residual limb length; and 6) the stiffness/compliance of the residual limb soft tissues may significantly alter the interface pressure distribution.

  5. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

    Directory of Open Access Journals (Sweden)

    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  6. Muscle activity during stance phase of walking: Comparison of males with transfemoral amputation with osseointegrated fixations to nondisabled male volunteers

    Directory of Open Access Journals (Sweden)

    Annette Pantall, DO(UK, PhD

    2013-07-01

    Full Text Available A recent development in prosthetics is the osseointegrated fixation (OF, with improvements in comfort, fatigue, hip movement, and ease of prosthetic attachment reported. However, little information is available regarding muscle function. This study reports on selected gait parameters of the residual limb during the stance phase of level overground walking, focusing on muscle activity. Five males with transfemoral amputation (TFA with OFs were recruited. Ground reaction force (GRF, lower-limb kinematics, and surface electromyography (sEMG from residual-limb muscles were recorded. sEMG data were also collected from a group of 10 nondisabled male subjects. Interstance variability of gait parameters was assessed by coefficient of multiple correlations. Repeatability of GRF and hip kinematics was high, whereas repeatability of the sEMG was low for four of the five individuals with TFA. Interstance variability of the sEMG for gluteus medius (GMED was significantly greater in the group with TFA. The main difference in sEMG between the groups was the phase, with GMED and adductor magnus displaying greater differences than their counterparts in the nondisabled group. Results demonstrate that muscles in the residual limb retain aspects of their previous functional pattern.

  7. Longitudinal gait analysis of a person with a transfemoral amputation using three different prosthetic knee/foot pairs.

    Science.gov (United States)

    Barr, J Bradley; Wutzke, Clinton J; Threlkeld, A Joseph

    2012-07-01

    Using gait analysis, we documented kinetic and temporospatial changes over a 7-year period in a single healthy individual with a transfemoral amputation walking with three different knees and matched foot components. The knee/foot pairs in chronological order were Four Bar Endolite knee/Endolite Dynamic Response foot; Ossur Total Knee 2000/Pathfinder I foot; and C-Leg knee/IC40 C-walk foot. The design of the suspension and socket were unchanged across the three prostheses. We found an increase in the braking component of A-P ground reaction force on the intact limb while using the C-Leg compared to the other two prosthetic fabrications. There was progressive change across the three component combinations, which included increased step length, increased walking velocity, and decreased double limb support time. The subject ranked the C-Leg system as the most stable. The final gait pattern with the C-Leg was faster, less cautious, and more stable than with the other prosthetic components.

  8. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: reliability of kinetic data.

    Science.gov (United States)

    Vertriest, Sofie; Coorevits, Pascal; Hagberg, Kerstin; Brånemark, Rickard; Häggström, Eva; Vanderstraeten, Guy; Frossard, Laurent

    2015-05-01

    This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an osseointegrated implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( %SEMs ). The ICCs of all variables were above 0.9 and the %SEM values ranged between 0 and 87%. This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.

  9. Muscle activity during stance phase of walking: comparison of males with transfemoral amputation with osseointegrated fixations to nondisabled male volunteers.

    Science.gov (United States)

    Pantall, Annette; Ewins, David

    2013-01-01

    A recent development in prosthetics is the osseointegrated fixation (OF), with improvements in comfort, fatigue, hip movement, and ease of prosthetic attachment reported. However, little information is available regarding muscle function. This study reports on selected gait parameters of the residual limb during the stance phase of level overground walking, focusing on muscle activity. Five males with transfemoral amputation (TFA) with OFs were recruited. Ground reaction force (GRF), lower-limb kinematics, and surface electromyography (sEMG) from residual-limb muscles were recorded. sEMG data were also collected from a group of 10 nondisabled male subjects. Interstance variability of gait parameters was assessed by coefficient of multiple correlations. Repeatability of GRF and hip kinematics was high, whereas repeatability of the sEMG was low for four of the five individuals with TFA. Interstance variability of the sEMG for gluteus medius (GMED) was significantly greater in the group with TFA. The main difference in sEMG between the groups was the phase, with GMED and adductor magnus displaying greater differences than their counterparts in the nondisabled group. Results demonstrate that muscles in the residual limb retain aspects of their previous functional pattern.

  10. Efeito prolongado de sistemas de preparo do solo com e sem cultivo de soqueira de cana crua em algumas propriedades físicas do solo Long-term effect of soil tillage systems with and without tillage of green-cane stump in soil physical properties

    Directory of Open Access Journals (Sweden)

    Fábio Camilotti

    2005-04-01

    Full Text Available Este trabalho foi conduzido em Latossolo Vermelho distrófico típico, sob cultivo de cana crua, com o objetivo de avaliar o efeito prolongado de sistemas de preparo do solo, com e sem cultivo da soqueira, e épocas de amostragem sobre algumas propriedades físicas do solo. O delineamento experimental foi o de blocos ao acaso, em esquema de parcelas subsubdivididas, sendo os tratamentos principais quatro sistemas de preparo do solo: (i controle da soqueira com duas gradagens, subsolagem e mais uma gradagem de nivelamento; (ii controle da soqueira com herbicida e uma subsolagem; (iii controle da soqueira com herbicida; (iv controle da soqueira com herbicida, aração com arado de aivecas e uma gradagem de nivelamento. Os tratamentos secundários foram: com cultivo e sem cultivo da soqueira. Os tratamentos ternários foram as épocas de avaliação: dois dias antes e após a quarta colheita da cultura. A porosidade total, macroporosidade, microporosidade e densidade do solo foram avaliadas, além do perfilhamento e da produtividade da cultura. Após quatro sucessivas colheitas de cana crua, houve redução da macroporosidade com aumento da microporosidade nas camadas abaixo de 10 cm e aumento da densidade do solo entre 20 e 50 cm. A densidade do solo não foi alterada de modo consistente em função de todos os tratamentos testados. O cultivo da soqueira favoreceu o aumento da macroporosidade com decréscimo na microporosidade, e o efeito inverso foi observado após a colheita. Os sistemas de preparo do solo e de cultivo da soqueira não afetaram o perfilhamento e a produtividade da cultura.This work was carried out at the field conditions in a Typic Haplustox soil with green-cane crop with the objective to evaluate long-term effect of soil tillage systems with and without tillage of stump in soil physical properties. A complete randomized blocks in split-split-plots arrangement of treatments were used. The principal treatments were four soil

  11. Comparative study of different treatment options of grade III and IV diabetic foot ulcers to reduce the incidence of amputations

    Directory of Open Access Journals (Sweden)

    Poras Chaudhary

    2013-02-01

    Full Text Available This study aims to compare the efficacy of antiseptic dressings, hyperbaric oxygen therapy, and recombinant human platelet derived growth factor (rhPDGF for two reasons: i to reduce the incidence of lower limb amputations in diabetic foot ulcer; ii to limit the duration of stay in the hospital. A prospective randomized trial was conducted on 60 patients with stage III and IV diabetic foot ulcers (International Association of Enterostomal Therapy classification and patients were divided randomly in three different therapy groups - antiseptics, hyperbaric oxygen therapy, recombinant platelet derived growth factor, with 20 patients in each group. Patients were managed initially on inpatient and then on outpatient basis till the ulcer healed completely. Results among three groups were compared using unpaired T test and the level of significance was set at P<0.05 using ANOVA. This study compares the efficacy of hyperbaric oxygen therapy, antiseptic dressings, and rhPDGF in grade III and IV diabetic foot ulcers. P value (0.0348 was significant for complete wound contraction while p value healing time (0.6534 and ulcer size (0.0593 in the groups was not significant. PDGF is safe, effective and easy to apply. Results are comparable with hyperbaric oxygen (HBO therapy and cost of treatment is lower than other therapies. Diabetic foot ulcer management requires multidisciplinary and aggressive approach. PDGF should be recommended for all grade III and IV diabetic foot ulcer at least 8 weeks old. HBO is equally good an option but has limitations and side effects.

  12. Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?

    Science.gov (United States)

    IJmker, T; Noten, S; Lamoth, C J; Beek, P J; van der Woude, L H V; Houdijk, H

    2014-09-01

    The aim of this study was to examine whether impaired balance control is partly responsible for the increased energy cost of walking in persons with a lower limb amputation (LLA). Previous studies used external lateral stabilization to evaluate the energy cost for balance control; this caused a decrease in energy cost, with concomitant decreases in mean and variability of step width. Using a similar set-up, we expected larger decreases for LLA than able-bodied controls. Fifteen transtibial amputees (TT), 12 transfemoral amputees (TF), and 15 able-bodied controls (CO) walked with and without external lateral stabilization provided via spring like cords attached to the waist. Effects of this manipulation on energy cost, step parameters, and pelvic motion were evaluated between groups. TT (-5%) and CO (-3%) showed on average a small reduction in energy cost when walking with stabilization, whereas TF exhibited an increase in energy cost (+6.5%) The difference in the effect of stabilization was only significant between TT and TF. Step width, step width variability, and medio-lateral pelvic displacement decreased significantly with stabilization in all groups, especially in TT. Contrary to expectations, external lateral stabilization did not result in a larger decrease in the energy cost of walking for LLA compared to able-bodied controls, suggesting that balance control is not a major factor in the increased cost of walking in LLA. Alternatively, the increased energy cost with stabilization for TF suggests that restraining (medio-lateral) pelvic motion impeded necessary movement adaptations in LLA, and thus negated the postulated beneficial effects of stabilization on the energy cost of walking. PMID:25108643

  13. Comparison of walking overground and in a Computer Assisted Rehabilitation Environment (CAREN in individuals with and without transtibial amputation

    Directory of Open Access Journals (Sweden)

    Gates Deanna H

    2012-11-01

    Full Text Available Abstract Background Due to increased interest in treadmill gait training, recent research has focused on the similarities and differences between treadmill and overground walking. Most of these studies have tested healthy, young subjects rather than impaired populations that might benefit from such training. These studies also do not include optic flow, which may change how the individuals integrate sensory information when walking on a treadmill. This study compared overground walking to treadmill walking in a computer assisted virtual reality environment (CAREN in individuals with and without transtibial amputations (TTA. Methods Seven individuals with traumatic TTA and 27 unimpaired controls participated. Subjects walked overground and on a treadmill in a CAREN at a normalized speed. The CAREN applied optic flow at the same speed that the subject walked. Temporal-spatial parameters, full body kinematics, and kinematic variability were collected during all trials. Results Both subject groups decreased step time and control subjects decreased step length when walking in the CAREN. Differences in lower extremity kinematics were small (○ and did not exceed the minimal detectable change values for these measures. Control subjects exhibited decreased transverse and frontal plane range of motion of the pelvis and trunk when walking in the CAREN, while patients with TTA did not. Both groups exhibited increased step width variability during treadmill walking in the CAREN, but only minor changes in kinematic variability. Conclusions The results of this study suggest that treadmill training in a virtual environment should be similar enough to overground that changes should carry over. Caution should be made when comparing step width variability and step time results from studies utilizing a treadmill to those overground.

  14. V.A. Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: III. Definitions and review of design and baseline characteristics.

    Science.gov (United States)

    Colwell, J A; Bingham, S F; Abraira, C; Anderson, J W; Kwaan, H C

    1985-01-01

    This report summarizes the major design features, methods, and baseline characteristics of patients enrolled in a Veterans Administration Cooperative Study. In eleven V.A. centers, 231 male diabetic patients who had either a recent amputation for gangrene (N = 207) or active gangrene (N = 24) were randomly assigned to a group which received aspirin (325 mg t.i.d.) plus dipyridamole (75 mg t.i.d.) (N = 110) or two placeboes t.i.d. (N = 121). Major end point were vascular death and amputation of the opposite extremity for gangrene. Forty-one percent of the 563 patients screened were enrolled during a 39 month period. Enrollment errors were found in 8.7%. Historically, the two groups were well matched regarding the following variables: age, duration of diabetes, insulin therapy, previous oral agent therapy, hypertension, myocardial infarction, congestive heart failure, renal disease, sensory neuropathy, and smoking. The drug therapy group had an increased frequency of a history of cerebrovascular disease (19% vs 7%, p = 0.01). The groups were well matched regarding amputation site, obesity, extent of lower extremity vascular disease, retinopathy, and neuropathy upon examination. Their baseline fasting values of glucose, cholesterol, triglycerides, and creatinine were also comparable. We conclude that this study should provide definitive data on the efficacy of these antiplatelet agents in preventing further vascular disease in this patient group. It should also provide new prospective data on the natural history of vascular disease, and the association of vascular risk factors with subsequent vascular events in this patient population.

  15. Determinants of Quality of Life in the Caregivers of Iranian War Survivors with Bilateral Lower-Limb Amputation after More than Two Decades

    OpenAIRE

    Zohreh Ganjparvar; Batool Mousavi; Mehdi Masumi; Mohammadreza Soroush; Ali Montazeri

    2016-01-01

    Background: Providing care to a disable relative at home exposes the caregiver to a potentially higher risk of physical and mental problems. We measured health-related quality of life (HRQOL) and its determinants among the caregivers of the Iranian survivors of the Iran-Iraq war (1980–1988) with bilateral lower-limb amputation. Methods: Data were collected from 464 individuals comprising war-related bilateral lower-limb amputees (n=232) and their caregivers (n=232) in January 2015 in Shira...

  16. Timing of access to secondary healthcare services for diabetes management and lower extremity amputation in people with diabetes: a protocol of a case-control study.

    LENUS (Irish Health Repository)

    Buckley, Claire M

    2013-09-03

    Lower extremity amputation (LEA) is a complication of diabetes and a marker of the quality of diabetes care. Clinical and sociodemographic determinants of LEA in people with diabetes are well known. However, the role of service-related factors has been less well explored. Early referral to secondary healthcare is assumed to prevent the occurrence of LEA. The objective of this study is to investigate a possible association between the timing of patient access to secondary healthcare services for diabetes management, as a key marker of service-related factors, and LEA in patients with diabetes.

  17. 宫颈残端癌53例临床特征及预后分析%Analysis of Prognosis and Clinical Characteristics of 53 Cases of Stump Cervical Cancer

    Institute of Scientific and Technical Information of China (English)

    赵婷婷; 王晶; 于丽波; 李文乐; 王春辉; 陈慧

    2012-01-01

    Objective:To analyze the clinical pathological characteristics and prognostic factors of the stump cervical cancer. Methods:Clinical data of 53 cases of stump cervical cancer were retrospectively analyzed using Chi-square test, Kaplan-Meier analysis,log-rank test,and COX regression model. Results:The median age of onset was 46 years, and the common clinical manifestation was irregular vaginal bleeding (24 cases ,45. 28%). Treatment for patients in I A1 ~ Ⅰ B1 and Ⅱ A1 stages was radical trachelectomy plus pelvic lymph node dissection. Treatment for patients in Ⅰ B2, ⅡA2 and ⅡB stages was neoadjuvant chemotherapy followed by radical trachelectomy plus pelvic lymph node dissection. Those patients without significant improvement after neoadjuvant chemotherapy could be switched to radiotherapy. Treatment for patients in Ⅲ A~ⅢB stages was radiation synchronous chemotherapy. 18 patients with the risk factors,includingtumor diameter > 4 cm,lymph node metastasis and low histological stage,were added the postsurgical radiation and (or) chemotherapy. The median overall survival was 45.9 months,and the 5-year overall survival rate was 53.2%. Multivariate analysis showed that FIGO stage (P = 0. 042), histological differentiation ( P = 0. 034), and vascular tumor thrombus( P=0.038) were independent prognostic factors. Vascular tumor thrombus was correlated to tumor size and histological differentiation. Conclusions:The main treatments for stump cervical cancerwere surgery and radiotherapy. Radical surgery would improve the overall survival. FIGO clinical stage,histological differentiation, and vascular tumor thrombus were independent prognostic risk factors for cervical stump cancer. Vascular tumor thrombus was correlated to tumor size and histological differentiation.%目的:探讨宫颈残端癌的临床特征及影响预后的因素,为临床诊治提供参考.方法:收集53例宫颈残端癌患者的临床资料进行回顾性分析,用卡方检验

  18. Estudo comparativo entre a resistência das suturas manual e mecânica do coto brônquico em cães submetidos a pneumonectomia esquerda Comparative study of the resistance of manual and mechanical sutures in the bronchial stump of dogs submitted to left pneumonectomy

    Directory of Open Access Journals (Sweden)

    Antônio Mauro Bof

    2007-04-01

    Full Text Available OBJETIVO: O objetivo do presente trabalho foi comparar a resistência da sutura manual e da sutura mecânica imediatamente após a sutura do coto brônquico esquerdo de cães submetidos a pneumonectomia. MÉTODOS: Foram utilizados 15 cães mestiços, de ambos os sexos, com peso variando entre 8 e 23 kg, distribuídos aleatoriamente em 2 grupos. No grupo I (n = 7, o fechamento do coto brônquico foi realizado com sutura manual (método de Sweet e, no grupo II, utilizou-se sutura mecânica com grampeador. Imediatamente após o fechamento do coto brônquico, foi provocado aumento da pressão intratraqueal de forma progressiva e controlada. RESULTADOS: A média de pressão de ruptura da linha de sutura do coto brônquico foi 33,71 mmHg no grupo I e 89,87 mmHg no grupo II (p OBJECTIVE: To compare the resistance of manual suture with that of mechanical suture immediately after the suture of the left bronchial stump of dogs submitted to pneumonectomy. METHODS: A total of 15 mixed-breed dogs of both genders, each weighing between 8 and 23 kg, were randomly divided into 2 groups. In group I (n = 7, the bronchial stump was sutured manually (the Sweet method and, in group II (n = 8, it was stapled. Immediately after the closure of the bronchial stump, the intratracheal pressure was progressively increased in a controlled manner. RESULTS: The mean rupture pressure of the bronchial stump suture line was 33.71 mmHg in group I and 89.87 mmHg in group II (p < 0.01. CONCLUSION: These data allowed us to conclude that mechanical suture of the bronchial stump, submitted to pressure immediately after closure, is more resistant than is manual suture in dogs submitted to pneumonectomy.

  19. Physical performance and self-report outcomes associated with use of passive, adaptive, and active prosthetic knees in persons with unilateral, transfemoral amputation: Randomized crossover trial

    Directory of Open Access Journals (Sweden)

    Brian J. Hafner, PhD

    2015-09-01

    Full Text Available Prosthetic knees are a vital component in an artificial limb. Contemporary knees include passive (mechanical, adaptive (computerized, or active (motorized control systems and have the potential to mitigate amputation-related functional impairments and activity limitations. A 14 mo randomized crossover trial was conducted. Participants (n = 12, mean age = 58 yr were tested under three conditions: passive control (existing knee, adaptive control (Ossur Rheo Knee II, and active control (Ossur Power Knee II. Training and acclimation time were provided to participants in the adaptive and active knees. Outcome measures included indoor tests (Timed Up and Go test [TUG], stairs, and ramp, outdoor tests (walking course and perceived exertion, step activity monitor, self-report surveys (mobility, balance confidence, physical function, fatigue, and general health, and fall incidence. Mixed-effects linear regression modeling was used to evaluate data. Compared with passive control, adaptive control significantly improved comfortable TUG time (difference = 0.91 s, p = 0.001 and reported physical function (difference = 1.26 [T-score], p = 0.03. Active control significantly increased comfortable TUG, fast TUG, and ramp times (difference = 3.02, 2.66, and 0.96 s, respectively, all p < 0.03 and increased balance confidence (difference = 3.77, p = 0.003 compared with passive control. Findings suggest that adaptive knee control may enhance function compared with passive control but that active control can restrict mobility in middle-age or older users with transfemoral amputation.

  20. Temporal adaptations in generic and population-specific quality of life and falls efficacy in men with recent lower-limb amputations

    Directory of Open Access Journals (Sweden)

    Cleveland T. Barnett, PhD

    2013-05-01

    Full Text Available This study examined the longitudinal changes in generic health-related quality of life (QOL, prosthesis-related QOL, falls efficacy, and walking speed in men with lower-limb amputations up to 6 months following discharge from rehabilitation. Seven male unilateral transtibial amputees completed the Medical Outcomes Study 36-Item Short Form Health Survey, the Prosthesis Evaluation Questionnaire, and the Modified Falls Efficacy Scale at 1, 3, and 6 months postdischarge from rehabilitation. Walking speed was also recorded to objectively assess participants’ mobility. Health-related QOL measures displayed increases, resulting in large effect sizes though not reaching statistical significance. Prosthesis-related QOL measures indicated that scales relating to the participants’ prostheses improved and the support of significant others was the most positively scored variable. Walking speed increased by 0.12 m/s, although it was not significantly related to indices of QOL or falls efficacy. Falls efficacy did not improve significantly during the study period, although it was strongly related to QOL (p < 0.05. These results provide a novel insight into how QOL and falls efficacy develop in people with lower-limb amputations, alongside changes in mobility, after discharge from rehabilitation. Further improvements in physical health following discharge may be required to elicit subsequent increases in overall QOL and concurrent improvements in falls efficacy.

  1. 电击伤截肢患者临床护理体会%Nursing care of patients with amputation caused by electrical injury

    Institute of Scientific and Technical Information of China (English)

    黄爱好; 林宝玉; 罗显利

    2011-01-01

    Objective To explore the nursing care for patients with amputation caused by electrical injury. Methods The data on 12 amputee patients were retrospectively reviewed. Holistic nursing was performed on all the patients. Effective care measures were made and incidence of complications was prevented promptly. Results 11 patients were cured, and one patient developed arterial bleeding but received timely management. Conclusions Effective holistic nursing, close observation of changes in disease severity, and prevention and timely treatment of complications are the key to the accleration of rehabilitation of patients with amputation caused by electrical injury.%目的 探讨对电击伤截肢患者的护理.方法 本组通过对12例患者进行回顾性回忆,采用护理程序的方式对患者整体的护理,及时采取有效的护理措施和预防并发症的发生.结果 11例患者治愈出院,有1例患者出现动脉出血达到及时处理.结论 实施有效的整体护理以及严密观察病情变化,预防并及时处理并发症,全面、有效的护理是促进电击伤患者康复的关键.

  2. 心理护理对截肢患者的影响%Influence of Psychological Nursing on Patients Undergoing Amputation

    Institute of Scientific and Technical Information of China (English)

    吕明英; 赵小林

    2015-01-01

    Objective To investigate the ef ects of psychological care on the prognosis of patients with amputation. Methods In recent years,our hospital admit ed 13 cases of psychological care of patients with dif erent causes of amputation experience.Results Early psychological nursing intervention,has important significance for the rehabilitation of amputees. Conclusion Patients with bet er psychological care can accept the status quo, with positive at itude towards life, restore social functions.%目的:探讨心理护理对截肢患者预后的影响。方法总结我院近年来收治的13例不同原因截肢的患者心理护理经验。结果早期进行心理护理干预,对截肢患者的康复具有重要意义。结论心理护理能使患者更好的接受现状,以积极向上的态度对待生活,恢复社会功能。

  3. Comparison between microprocessor-controlled ankle/foot and conventional prosthetic feet during stair negotiation in people with unilateral transtibial amputation

    Directory of Open Access Journals (Sweden)

    Adam A. Finnieston, CPO, LPO

    2013-10-01

    Full Text Available Contrary to stance-phase dorsiflexion of conventional prosthetic feet, the microprocessor-controlled Proprio foot permits swing-phase dorsiflexion on stairs. The purpose of this study was to compare Symmetry in External Work (SEW between a microprocessor-controlled foot and conventional prosthetic feet in two groups with unilateral transtibial amputation (Medicare Functional Classification Levels K-Level-2 and K-Level-3 during stair ascent and descent. Ten subjects were evaluated while wearing three conventional prosthetic feet—solid ankle cushion heel (SACH, stationary attachment flexible endoskeleton (SAFE, and Talux-and the Proprio foot using a study socket and were given a 10- to 14-day accommodation period with each foot. Ground reaction forces were collected using F-scan sensors during stair ascent and descent. The SEW between the intact and amputated limbs was calculated for each foot. During stair ascent, the Proprio foot resulted in a higher interlimb symmetry than conventional prosthetic feet, with significant differences between the Proprio and SACH/SAFE feet. The swing-phase dorsiflexion appeared to promote greater interlimb symmetry because it facilitated forward motion of the body, resulting in a heel-to-toe center of pressure trajectory. During stair descent, all feet had low symmetry without significant differences between feet. The movement strategy used when descending stairs, which is to roll over the edge of a step, had a greater influence on symmetry than the dorsiflexion features of prosthetic fee

  4. Comparison between microprocessor-controlled ankle/foot and conventional prosthetic feet during stair negotiation in people with unilateral transtibial amputation.

    Science.gov (United States)

    Agrawal, Vibhor; Gailey, Robert S; Gaunaurd, Ignacio A; O'Toole, Christopher; Finnieston, Adam A

    2013-01-01

    Contrary to stance-phase dorsiflexion of conventional prosthetic feet, the microprocessor-controlled Proprio foot permits swing-phase dorsiflexion on stairs. The purpose of this study was to compare Symmetry in External Work (SEW) between a microprocessor-controlled foot and conventional prosthetic feet in two groups with unilateral transtibial amputation (Medicare Functional Classification Levels K-Level-2 and K-Level-3) during stair ascent and descent. Ten subjects were evaluated while wearing three conventional prosthetic feet- solid ankle cushion heel (SACH), stationary attachment flexible endoskeleton (SAFE), and Talux-and the Proprio foot using a study socket and were given a 10- to 14-day accommodation period with each foot. Ground reaction forces were collected using F-scan sensors during stair ascent and descent. The SEW between the intact and amputated limbs was calculated for each foot. During stair ascent, the Proprio foot resulted in a higher interlimb symmetry than conventional prosthetic feet, with significant differences between the Pro prio and SACH/SAFE feet. The swing-phase dorsiflexion appeared to promote greater interlimb symmetry because it facilitated forward motion of the body, resulting in a heel-to-toe center of pressure trajectory. During stair descent, all feet had low symmetry without significant differences between feet. The movement strategy used when descending stairs, which is to roll over the edge of a step, had a greater influence on symmetry than the dorsiflexion features of prosthetic feet.

  5. Bloqueio isquiático-femoral guiado por ultra-som para revisão de coto de amputação: relato de caso Bloqueo isquiático-femoral guiado por ultrasonido para revisión de muñón de amputación: relato de caso Ultrasound-guided sciatic-femoral block for revision of the amputation stump: case report

    OpenAIRE

    Pablo Escovedo Helayel; Diogo Bruggemann da Conceição; Carla Feix; Gustavo Luchi Boos; Bruno Schroder Nascimento; Getúlio Rodrigues de Oliveira Filho

    2008-01-01

    JUSTIFICATIVA E OBJETIVOS: O emprego da ultra-sonografia na anestesia regional vem se tornando cada vez mais difundido pelo seu papel facilitador e pela sua eficácia. A visualização direta por meio da ultra-sonografia permite que se identifiquem os nervos periféricos, independentemente da capacidade de se obter estimulação sensitiva ou motora. RELATO DO CASO: Paciente submetido à revisão de coto de amputação no nível do joelho sob bloqueio isquiático-femoral guiado por ultra-som com 40 mL de ...

  6. A Real World, Observational Registry of Chronic Wounds and Ulcers

    Science.gov (United States)

    2016-05-18

    Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump

  7. 38 CFR 4.63 - Loss of use of hand or foot.

    Science.gov (United States)

    2010-07-01

    ... amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The... circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will...

  8. Clinical study on Tangshukang liquid on diabetic foot amputation rate%唐舒康液对糖尿病足截肢率的影响

    Institute of Scientific and Technical Information of China (English)

    吕志强

    2010-01-01

    Objective To investigate the effects of Tangshukang liquid on the rate of diabetic foot amputation.Methods 80 patients with diabetic foot were divided into two groups (40 ones in each group) by single-blind method. On the basis of conventional treatment of controlling blood glucose, preventing infection, improving microcirculation and carrying out partial debridement for both groups, the treatment group was applied Tangshukang liquid (homemade) externally, and the control group was applied gauze of mixture liquid (gentamiycin+654-2+insulin) externally. Both groups were treated with 4 therapeutic courses (30 days equal one therapeutic course). Therapeutic effects were observed after the treatment. Results Amputation rate of diabetic foot was significantly reduced in the treatment group, especially the patients with wet gangrene.Conclusion Tangshukang Liquid can significantly reduce the amputation rate of diabetic foot and has good effect on diabetic foot with wet gangrene.%目的 观察唐舒康液对糖尿病足截肢率的影响.方法 将80例糖尿病足患者采用单盲法按随机数字表法随机分为两组各40例,在控制血糖、抗感染、改善微循环、局部清创处理的基础上,治疗组外敷中药(浸泡纱条)唐舒康液(自制),对照组外用混合液纱布(庆大霉素+654-2+胰岛素),两组患者均于每日早、晚各换药1次,治疗30 d为1个疗程,4个疗程后观察疗效.结果 治疗组总有效率为95.0%,对照组为80.0%,两组总有效率比较,差异有统计学意义(U=2.362,P<0.05).结论 唐舒康液可降低糖尿病足的截肢率,对湿性坏疽效果更佳.

  9. Auto-amputation of penis due to carcinoma: Still a threat in the era of modern medicine: Report of two cases

    Directory of Open Access Journals (Sweden)

    Bastab Ghosh

    2013-01-01

    Full Text Available Incidence of penile carcinoma is decreasing worldwide. Nevertheless, the incidence of penile cancer is still significant in various tropical countries, and it often presents in advanced stage. We report two unique cases of penile auto-amputation due to advanced cancer and review relevant literature. Both the patients presented with ulcerative lesion replacing penile base following automatic sloughing of the whole penis and voiding dysfunction. In addition, the first patient had metastatic inguinal lymph nodes. Supra-pubic urinary diversion was the initial management in both the patients. The first patient was treated with combined chemo-radiation, but he succumbed to death following two cycles of chemotherapy. The second patient was successfully treated with total penectomy and perineal urethrostomy. He recovered well but was lost to follow-up.

  10. Restoring motor control and sensory feedback in people with upper extremity amputations using arrays of 96 microelectrodes implanted in the median and ulnar nerves

    Science.gov (United States)

    Davis, T. S.; Wark, H. A. C.; Hutchinson, D. T.; Warren, D. J.; O'Neill, K.; Scheinblum, T.; Clark, G. A.; Normann, R. A.; Greger, B.

    2016-06-01

    Objective. An important goal of neuroprosthetic research is to establish bidirectional communication between the user and new prosthetic limbs that are capable of controlling >20 different movements. One strategy for achieving this goal is to interface the prosthetic limb directly with efferent and afferent fibres in the peripheral nervous system using an array of intrafascicular microelectrodes. This approach would provide access to a large number of independent neural pathways for controlling high degree-of-freedom prosthetic limbs, as well as evoking multiple-complex sensory percepts. Approach. Utah Slanted Electrode Arrays (USEAs, 96 recording/stimulating electrodes) were implanted for 30 days into the median (Subject 1-M, 31 years post-amputation) or ulnar (Subject 2-U, 1.5 years post-amputation) nerves of two amputees. Neural activity was recorded during intended movements of the subject’s phantom fingers and a linear Kalman filter was used to decode the neural data. Microelectrode stimulation of varying amplitudes and frequencies was delivered via single or multiple electrodes to investigate the number, size and quality of sensory percepts that could be evoked. Device performance over time was assessed by measuring: electrode impedances, signal-to-noise ratios (SNRs), stimulation thresholds, number and stability of evoked percepts. Main results. The subjects were able to proportionally, control individual fingers of a virtual robotic hand, with 13 different movements decoded offline (r = 0.48) and two movements decoded online. Electrical stimulation across one USEA evoked >80 sensory percepts. Varying the stimulation parameters modulated percept quality. Devices remained intrafascicularly implanted for the duration of the study with no significant changes in the SNRs or percept thresholds. Significance. This study demonstrated that an array of 96 microelectrodes can be implanted into the human peripheral nervous system for up to 1 month durations. Such an

  11. El error neurocientífico de Descartes, entre Spinoza y Aquinas. El debate entre Damasio y Stump sobre el carácter eliminativo o vitalista del materialismo en la neuroética, neuropolítica y neuroeconomía

    OpenAIRE

    Carlos Ortiz de Landázuri

    2016-01-01

    Se analiza el debate entre Eleonore Stump y Antonio Damasio a propósito de dos posibles estrategias a la hora de superar el “error” neurocientífico del dualismo cartesiano respecto de la correlación entre mente y cerebro, a saber: o bien se corrige el “error” neurocientífico de Descartes desde un modelo híbrido de tipo monista como el de Spinoza que ahora también se utiliza para justificar un materialismo eliminativo aún más radicalizado, a pesar de seguir manteniendo de un modo meramente he...

  12. The Risk Factors Related to Lower Extremity Amputations in Patients Suffered from Severe Diabetic Foot Infections%糖尿病足感染截肢(趾)相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘倩; 王鹏华; 张达; 杨蔚; 孙茜; 褚月颉; 李代清

    2013-01-01

    Objective To analyze risk factors of lower extremity amputations in patients with severe infective diabetic foot ulcers. Methods The total of 1 076 patients with diabetic foot ulcers was included in this study. All patients with severe diabetic foot infections were selected (PEDIS grade 3-4) by PEDIS infection classification,and divided into three groups including non-amputation group (group A,n=48),healing after minor amputations (group B,n =162) and administered amputations above ankle-level (group C,n=70). The biochemical indicators and SAD score were measured and compared in groups of patients. The multiple Logistic regression analysis was used to observe the factors affect small amputation (toe) and amputation. Results The multivariate analysis showed that platelet count,serum uric acid and the degree of peripheral vascular diseases (SAD score) were independent predictors of minor amputations in the patients with severe infections. Besides the above factors,the plasma fibrinogen and the depth of ulcer (scored by SAD) were the factors related to the risk of major amputation. Conclusion It was found that the platelet count,serum uric acid,plasma fibrinogen,the Charlson score,the degree of peripheral vascular diseases and the depth of ulcer can predict the amputation-risk in diabetic foot patients with severe infections.%目的 研究除感染因素外影响感染程度的糖尿病足溃疡患者行大(小)截肢(趾)的因素.方法 选取PEDIS感染分级3~4级的糖尿病足病已愈合的患者1 076例,分未手术愈合组(A组,48例)、小截肢(趾)愈合组(B组,162例)、大截肢愈合组(C组,70例).测量并比较各组患者生化指标和SAD评分,采用多因素Logistic回归分析影响小截肢(趾)和大截肢的因素.结果 患者的血小板水平、血尿酸水平与SAD评分中的动脉病变是其行小截肢(趾)手术的影响因素.而患者的血小板水平、血尿酸水平、血浆纤维蛋白原水平、Charlson评分和患

  13. Epistemologia sobre amputações e desbridamentos de membros inferiores realizados no Hospital Universitário de Maringá Epistemology of lower limb amputations and debridements at Hospital Universitário de Maringá

    Directory of Open Access Journals (Sweden)

    Amélia Cristina Seidel

    2008-12-01

    Full Text Available CONTEXTO: Não há estatísticas precisas sobre o número de amputações realizadas anualmente, mas é conhecido o comprometimento da qualidade de vida desses indivíduos e a necessidade de uma equipe multiprofissional para sua reabilitação. OBJETIVO: Analisar todas as amputações de membros inferiores realizadas pelo Serviço de Angiologia e Cirurgia Vascular do Hospital Universitário Regional de Maringá entre 2000 e 2006. MÉTODOS: Estudo descritivo e retrospectivo a partir dos prontuários de pacientes submetidos a amputação ou desbridamento cirúrgico de membros inferiores por trauma ou doença vascular. RESULTADOS: Ocorreram 116 procedimentos, sendo 84,5% amputações e 15% desbridamentos cirúrgicos, em 111 pacientes, sendo 78 homens e 33 mulheres, cuja média das idades foi de 63,4 anos (4 a 100 anos, sendo os principais fatores etiológicos: doenças vasculares (92,8% e trauma (7,2%. As comorbidades e fatores de risco mais prevalentes foram: hipertensão arterial sistêmica (66%, diabetes melito (60%, tabaco (28% e arritmia cardíaca (0,9%. Quanto à escolaridade, se observou que 52,2% dos pacientes cursaram apenas o ensino fundamental, 6,5% fizeram o ensino médio, completo ou incompleto, e 41,3% eram analfabetos. A percentagem de pacientes submetidos à amputação primária foi de 94,9%, e secundárias, 5,1%. No entanto, houve diminuição progressiva do coeficiente desses procedimentos a cada ano. CONCLUSÕES: Este trabalho permite inferir que a incidência de amputação de membros inferiores foi maior no sexo masculino e teve como principal causa a doença aterosclerótica, mas apresentou uma redução progressiva.BACKGROUND: There are no precise data on the number of amputations performed every year. However, the decrease in quality of life of patients submitted to amputation is well-known, as is the need to involve a multidisciplinary team in the rehabilitation of these individuals. OBJECTIVE: To analyze all lower limb

  14. Clinical analysis of vaginal Lactobacillus live capsule combined with compound Phellodendron liquid in promoting the healing of vaginal stump after hysterectomy%阴道用乳杆菌活菌胶囊联合复方黄柏液促进子宫全切术后阴道残端愈合的临床分析

    Institute of Scientific and Technical Information of China (English)

    陈镘如; 梅立; 廖治; 谢兰

    2016-01-01

    Objective To investigate the clinical effect of vaginal Lactobacillus live capsule combined with compound Phellodendron liquid in promoting the healing of vaginal stump after hysterectomy .Methods 160 patients underwent hysterectomy due to gynecological benign or non inflammatory diseases in Department of gynecology of Sichuan Provincial People's Hospital from Jan 2014 to Dec 2014 were divided into research group and control group randomly , 80 cases in each group .10 days after the operation , the cases in research group were dealt with compound Phellodendron liquid dilution of the sitting basin , once a day , and then vaginal Lactobacillus live capsule was placed , 1 tablet per day , this kind of treatment lasted for 10 days; the control group without drug . Compared vaginal stump healing rate , vaginal stump hemorrhage rate , vaginal stump granulation tissue formation rate , vaginal cleanliness abnormality rate , vaginal dysbacteriosis rate , bacterial vaginal disease rate of two groups .Results Class-A healing rate of research group was 88.75 %, higher than that of control group ( 72.5 %) , and the difference was statistically significant ( P<0.05).Vaginal stump hemorrhage rate,vaginal stump granulation formation rate, the abnormal rate of vaginal cleanliness, vaginal dysbacteriosis rate and bacterial vaginal disease rate of research group were lower than those of the control group , and the differences were statistically significant ( P<0.05 ) .Conclusion Vaginal Lactobacillus live capsule combined with compound Phellodendron liquid can reduce the inflammatory reaction of vaginal stump , regulate the vaginal flora , improve the vaginal environment , reduce the occurrence of vaginitis and promote the healing of vaginal stump .%目的:探讨阴道用乳杆菌活菌胶囊(定君生)联合复方黄柏液外用对促进子宫全切术后阴道残端愈合的临床疗效。方法选取2014年因妇科良性、非炎症性疾病在四川省人民

  15. Phantom limb pain: a case of maladaptive CNS plasticity?

    DEFF Research Database (Denmark)

    Flor, Herta; Nikolajsen, Lone; Jensen, Troels Staehelin

    2006-01-01

    Phantom pain refers to pain in a body part that has been amputated or deafferented. It has often been viewed as a type of mental disorder or has been assumed to stem from pathological alterations in the region of the amputation stump. In the past decade, evidence has accumulated that phantom pain...

  16. Clinical analysis of diabetic foot and the epidemiology of diabetic foot amputation%糖尿病足流行病学及糖尿病足截肢的临床分析

    Institute of Scientific and Technical Information of China (English)

    彭小兵

    2015-01-01

    Objective Discussion for diabetic foot (DF) patients were analyzed epidemiological situation and amputation.Methods Our hospital in October 2012 -2014 October diabetes, diabetic foot and DF patients require amputation. The clinical data of all patients were analyzed retrospectively. Statistics clinical diabetic foot amputation rate, and analyze the reasons for amputees after the completion, resulting in clinical death.Results Clinical manifestations of diabetic foot in a higher amputation rate.For patients with diabetic foot amputation, after the completion of their cases with surgical wound healing in patients with amputation, as well as whether the patient showed a partial case of infection in the presence of a close relationship. Patients with diabetic foot main cause of death for patients appeared in the case of multiple organ failure. The deadline for the 10 patients, 1 patient clinical death, the remaining patients in the healing section showed significant differences in the extent (P<0.05).Conclusion For patients with diabetic foot disease, more common in the elderly population. For amputees, after its complete amputation surgery ensure good blood supply, which can effectively ensure the effective healing of surgical incisions. For diabetic foot amputation patients before surgery, after surgery, the patient needs to make the necessary comprehensive treatment, the patient's body organ function effectively guarantee all normal, you can effectively deal with stress situations for surgery, reduce postoperative mortality.%目的:探讨针对糖尿病足(DF)患者,对其流行病学以及截肢的情况进行分析。方法选取该院2012年10月—2014年10月糖尿病患者、糖尿病足患者以及需要截肢的DF患者。对所有患者的临床资料进行回顾性分析。统计糖尿病足患者临床截肢率,并分析患者完成截肢后,导致患者临床死亡的原因。结果糖尿病足患者于临床表现出较高的截肢率。针对糖尿

  17. 糖尿病足流行病学及糖尿病足截肢的临床分析%Clinical analysis of diabetic foot and the epidemiology of diabetic foot amputation

    Institute of Scientific and Technical Information of China (English)

    彭小兵

    2015-01-01

    Objective Discussion for diabetic foot (DF) patients were analyzed epidemiological situation and amputation.Methods Our hospital in October 2012 -2014 October diabetes, diabetic foot and DF patients require amputation. The clinical data of all patients were analyzed retrospectively. Statistics clinical diabetic foot amputation rate, and analyze the reasons for amputees after the completion, resulting in clinical death.Results Clinical manifestations of diabetic foot in a higher amputation rate.For patients with diabetic foot amputation, after the completion of their cases with surgical wound healing in patients with amputation, as well as whether the patient showed a partial case of infection in the presence of a close relationship. Patients with diabetic foot main cause of death for patients appeared in the case of multiple organ failure. The deadline for the 10 patients, 1 patient clinical death, the remaining patients in the healing section showed significant differences in the extent (P<0.05).Conclusion For patients with diabetic foot disease, more common in the elderly population. For amputees, after its complete amputation surgery ensure good blood supply, which can effectively ensure the effective healing of surgical incisions. For diabetic foot amputation patients before surgery, after surgery, the patient needs to make the necessary comprehensive treatment, the patient's body organ function effectively guarantee all normal, you can effectively deal with stress situations for surgery, reduce postoperative mortality.%目的:探讨针对糖尿病足(DF)患者,对其流行病学以及截肢的情况进行分析。方法选取该院2012年10月—2014年10月糖尿病患者、糖尿病足患者以及需要截肢的DF患者。对所有患者的临床资料进行回顾性分析。统计糖尿病足患者临床截肢率,并分析患者完成截肢后,导致患者临床死亡的原因。结果糖尿病足患者于临床表现出较高的截肢率。针对糖尿

  18. Effects of early psychological intervention on Patients with traumatic amputation%创伤截肢患者早期心理干预的效果

    Institute of Scientific and Technical Information of China (English)

    闵恒; 宁资社; 朱丹

    2012-01-01

    Objective To explore effect of early psychological intervention on Patients with traumatic amputation . Methods 76 cases of research object according to the sequence of admission were incorporated into the intervention group and control group, patients in the intervention group in patients on admission, as before the amputation, after the implementation of psychological intervention and daily 30min. In patients at admission, at discharge, and 3 months after discharge to assess its mental state. Results when admission with anxiety depression and the detection rate were 94.3% and 85.6%; After the intervention, the intervention group on discharge from the hospital patients, three months after anxiety, depression levels than that of the control group patients decreased obviously, the difference was statistically significant (P < 0.05). Conclusion early psychological intervention can significantly reduce the trauma of early amputees depression and anxiety level, and improve the overall mental state.%目的:探讨对创伤截肢患者早期心理干预的措施.方法:将76例研究对象按照入院先后顺序分别纳入到对照组和干预组,干预组患者在患者入院时、截肢前、后实施心理干预每日30min.于患者入院时、出院时、出院后3个月评定其心理状态.结果:患者入院时焦虑、抑郁检出率分别为94.3%和85.6%;经干预后,干预组患者出院时、出院后3个月焦虑、抑郁水平均较对照组患者明显下降,差异有统计学意义(P<0.05).结论:早期心理干预可显著降低创伤截肢患者早期的焦虑、抑郁水平,改善其总体心理状况.

  19. Surgical amputation of a digit and vacuum-assisted-closure (V.A.C.) management in a case of osteomyelitis and wound care in an eastern black rhinoceros (Diceros bicornis michaeli).

    Science.gov (United States)

    Harrison, Tara M; Stanley, Bryden J; Sikarskie, James G; Bohart, George; Ames, N Kent; Tomlian, Janice; Marquardt, Mark; Marcum, Annabel; Kiupel, Matti; Sledge, Dodd; Agnew, Dalen

    2011-06-01

    A 14-yr-old female eastern black rhinoceros (Diceros bicornis michaeli) presented with progressive suppurative osteomyelitis in her left hind lateral toe. beta-Hemolytic Streptococcus sp. was isolated. The animal was treated with multiple systemic antibiotics, and topical wound cleansing. Repeated debridements and nail trimmings were performed for 5 mo prior to electing amputation. The toe was surgically amputated under general anesthesia between the first and second phalanges. Analgesia was diffused into the wound topically via a catheter and elastomeric pump. The open amputation site was covered with adherent drapes and a negative-pressure wound therapy device provided vacuum-assisted closure (V.A.C.) for 72 hr. Three months later this animal developed a deep dermal ulcer on the lateral aspect of the right hind limb, at the level of the stifle. Methicillin-resistant Staphylococcus aureus was isolated. The wound was managed by initial daily lavage, followed by 1 mo of V.A.C. therapy, with 72 hr between dressing changes. Clinically, this therapy expedited the formation of healthy granulation tissue and overall healing was accelerated. The animal tolerated the machine and bandage changes well via operant conditioning. The use of negative-pressure wound therapy appeared to shorten time to resolution of slow-healing wounds in black rhinoceros. PMID:22946413

  20. 毕Ⅱ式胃切除术后胆总管十二指肠残端吻合术%Choledocho duodenal stump anastomisis after Billroth Ⅱ subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    楼立新; 施维锦

    2001-01-01

    Objective:To discuss the clinical effect and value of modified choledochoduodenostomy.Methods:We retrospectively analyzed fifteen cases after subtotal gastrectomy Billroth Ⅱ. These patients received choledocho-duodenal stump anastomosis and were followed up for an average of eight years.Results:None of the 15 cases suffered from stricture of the anastomosis stoma or retrograde biliary infection. Three cases accepted reoperation but none was because of stricture or retrograde infection.Conclusion:Choledochoduodenostomy after subtotal Billroth Ⅱ gastrectomy is reliable operation, which can prevent entero-biliary reflux and retrograde biliary infection. It also prevents anastomosis stricture induced by chironic drawing. So this operation is safet with, rare complications, so it is suitable for elder and serious patients, or for postoperation of upper abdomon. But the complication of blind loop syndrom still exits, which should be explored in future studies.%目的:探讨经改良后的胆总管十二指肠吻合术,在胆肠吻合中的疗效及应用价值。 方法:对15例行Billroth Ⅱ式胃大部切除术后,十二指肠残端与胆总管进行吻合的病例资料进行回顾分析,并进行术后疗效的随访观察。结果:本组15例经8个月至14年(平均随访8年)的远期随访,无1例发生吻合口狭窄及胆道逆行感染。随访中3例因症状复发而再次手术,但术后证实无1例症状是由吻合口狭窄或逆行感染引起。结论:行Billroth Ⅱ式胃大部切除术后,将排外的十二指肠与胆总管吻合,可克服胆肠返流、胆道逆行感染、吻合口慢性牵拉造成狭窄等缺点,具有手术安全性大、术后并发症少、可大大缩短手术时间等优点,尤其适用于年老体弱、病情危重、且有多次上腹部手术史的病人。但产生盲端综合征的问题可能依旧存在,值得以后在吻合术式的选择中进一步探讨。