[Indications for amputation].

Deathhead cockroaches employ characteristic postural strategies for surmounting barriers. These include rotation of middle legs to re-direct leg extension and drive the animal upward. However, during climbing the excursions of the joints that play major roles in leg extension are not significantly altered from those seen during running movements. To determine if the motor activity associated with these actions is also unchanged, we examined the electromyogram activity produced by the slow trochanteral extensor and slow tibial extensor motor neurons as deathhead cockroaches climbed over obstacles of two different heights. As they climbed, activity in the slow trochanteral extensor produced a lower extension velocity of the coxal-trochanteral joint than the same frequency of slow trochanteral extensor activity produces during horizontal running. Moreover, the pattern of activity within specific leg cycles was altered. During running, the slow trochanteral extensor generates a high-frequency burst prior to foot set-down. This activity declines through the remainder of the stance phase. During climbing, motor neuron frequency no longer decreased after foot set-down, suggesting that reflex adjustments were made. This conclusion was further supported by the observation that front leg amputees generated even stronger slow trochanteral extensor activity in the middle leg during climbing movements.

Amputation, Surgical↗

PubMed2002

Madura foot in the U.K.: fungal osteomyelitis after renal transplantation.

We report the case of an ethnic Asian patient who attended the renal transplant follow-up clinic complaining of pain in the right great toe. He had undergone transplantation nine months earlier and was maintained on triple immunosuppression. Initially, a clinical diagnosis of gout was made and the patient treated with analgesia. Two weeks later he remained symptomatic and developed a discharging sinus on his toe. A plain X-ray revealed a lytic lesion with minimal periosteal reaction. Aspiration of his first right metatarsal phalangeal joint was performed and fungal hyphae were observed in the fluid. Subsequently, despite surgical debridement and treatment with Itraconozaole amputation of the toe was required. Microbiological analysis revealed the organism to be Madurella grisea,which was resistant to both Itraconazole and Amphotericin B. He has remained well since amputation. We believe this to be the first case of Madurella infection to be described in a transplant patient.

Amputation, Surgical↗