Intractable congestive heart failure following brachiocephalic interposition saphenous vein arteriovenous fistula.
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Infection is potentially the most serious complication of total joint arthroplasty. Over the last 10 years, considerable advances have been made in the diagnosis and management of the infected implant. Modern methods of treatment are successful in up to 90% of cases in the lower limb, and results appear to be improving in the upper limb. This review places recent advances in the context of previous published work in the field.
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The last 40 years has witnessed revolutionary changes in vascular access provision for haemodialysis. Autogenous arteriovenous (AV) fistula is the best access modality and should be considered first when planning vascular access. Education is required to ensure preservation of the cephalic veins in patients at potential risk for the development of end stage renal disease (ESRD). The best access procedure should be performed first and the AV fistula allowed to mature before use. Autogenous AV fistula have a cumulative patency of 85-90% and 60-85% at 1 and 3 years respectively. Increased use of preoperative imaging and the use of autogenous vein are essential to improved long-term results.
Locked anterior dislocation of the superior radioulnar joint occurred in a 26-year-old man. The configuration of the associated radial head fracture maintained the locked position and predisposed to recurrence after open reduction. Radial head excision was necessary to resolve the problem. Both medial ligament repair and a radial head prosthesis were necessary to stabilize the elbow.
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As of 1980, approximately 1,800,000 people reached the age of 65 each year in the United States. It may be estimated that each year 35,000 of these people would benefit from total hip replacement surgery and are medically fit for it. Numbers for knee replacement are similar. Other joint replacements are much less in number but may be equally done when indicated. With the constant improvement of surgical technique, prostheses, and medical expertise, these people can be offered significant improvement in the quality of life by replacement of painful disabling joints.
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If no higher risk operation for the older patient is involved, indication for an arthroplastic joint prosthesis is given on the basis of today's large and world-wide experience. The postoperative mortality is naturally higher than with the younger patients and amounts to 2% in our statistics. A smooth cooperation between the internist and the orthopaedic surgeon enables also to the older patients with higher risk operations, especially thanks to the modern anaesthetic possibilities (f.i. lumbar anaesthetics), a functional recovery of the joint. We should, however, use already with the younger patients all possible joint preserving and supporting surgical operations in order to save the old patients in many cases from the need of implanting a prosthesis.
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We studied the relationship between kinematically unconstrained activities of daily living (ADL) tasks and a kinematically constrained task in above-elbow (AE) amputee subjects using myoelectrically controlled prostheses. Four men, 24 to 49 years old, with unilateral AE amputation wore a prosthesis interfaced to a programmable controller to emulate two different elbow control schemes, conventional velocity and a new "natural" controller. Subjects were timed during three ADL tasks--cutting meat, donning socks, and rolling dough--with both controllers. The prosthesis emulator was then connected to a crank device with a handle, and the subjects turned the crank from bottom to top positions in a vertical plane using each controller. Synergistic shoulder-elbow joint coordination required for crank turning was quantified as the maximum slope of the change in elbow torque versus the change in crank-angle. Performance between the two controllers differed significantly for the crank test but not for ADL tasks. One subject did not complete all crank turning tests. Positive canonical correlation of 0.77 was found between time and crank domain measures. We conclude that biomechanical assessments should be integrated with time-based clinical tests to comprehensively evaluate performance of AE amputee subjects with a myoelectric device.