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PubMed1987

Repeatability of kinetic and kinematic measurements in gait studies of the lower limb amputee.

During the last few years considerable attention has been given to the use of gait analysis as a tool for clinical use. The instrumentation for measurement of the kinetics and kinematics of human locomotion was originally designed for research use. Extension of its use into the clinical field calls for simplified methodology and clearly defined protocols with precise identification of the relevant parameters for the analysis. Force platforms, TV-computer and pylon transducer systems were used for collection of kinetic and kinematic data of five normal subjects, 10 below-knee, 10 above-knee and one hip disarticulation amputee. The repeatability tests showed significant differences in the measured parameters. These variations are attributed to the methodology of the analysis and the step to step variation of the subjects' gait. Differences in the degree of step to step variation between various amputee and normal subjects are quantified. In this presentation the capability of present day systems to perform repeatable gait measurements is discussed. A computational method for determination of representative measurements for the purposes of biomechanical evaluation and comparison as well as quantification of the degree of repeatability is described.

Adult↗
PubMed1991

A personal experience.

David Bailey, who is 14 years old, has a left transverse total forearm deficiency and bilateral longitudinal femur partial deficiencies. The latter fall into Torode and Gillespie's Group I, with marked femoral shortening. A wedge osteotomy was performed for his gross right coxa vara, which was successful, but an intractable fixed flexion deformity of the right knee led eventually to a knee disarticulation being performed.

Abnormalities, Multiple↗
PubMed1993

Walking speed of normal subjects and amputees: aspects of validity of gait analysis.

This study investigated some aspects of the validity of walking speed recording in 15 normal subjects, 16 trans-femoral amputees and 8 knee disarticulation amputees. The variability and test-retest reliability of walking speed and the influence of simultaneous recording of EMG and goniometry on comfortable and fast walking speeds were studied. The variability between sessions was mainly determined by the variance within each session. The variance of speed within sessions while walking with fast speed, was higher when walking without equipment than when walking with equipment. The variances of speed within sessions of the normal subjects were higher than those for both amputee groups. The test-retest reliability, expressed by the intra-class correlation coefficient, was good: between 0.83 and 0.98. The speed when walking without equipment was significantly higher both in normal subjects and amputees than the speed when walking with equipment.

Adolescent↗
PubMed1994

Functional outcome of rehabilitated bilateral lower limb amputees.

The functional outcome of rehabilitated bilateral lower limb amputees was studied. The study included 31 amputees who were admitted during 1980-1990 to a rehabilitation centre in the north of the Netherlands. The clinical notes made during the patients' admission were studied to obtain information about their characteristics, while mobility and prosthetic use were studied at discharge. The patients who were alive and willing to participate in the study were interviewed by a physician at their residence in November 1992, using among other things, the Sickness Impact Profile (SIP) and the Life Satisfaction questionnaire. Some 25 of the 31 patients were amputated for vascular reasons, 1 patient primarily for traumatic reasons and secondarily for vascular reasons, 5 patients for traumatic reasons. Eight patients had a bilateral trans-femoral amputation, 18 patients a bilateral trans-tibial amputation, 2 patients a combination of trans-tibial and knee-disarticulation amputation, 3 patients a trans-femoral/trans-tibial amputation. Mean age at second amputation was 66.3 years. Of the 31 amputees 21 were men and 10 women, 25 amputees were prosthetically rehabilitated during admission, 3 of them died during admission and 5 did not achieve mobility at discharge. In their activities of daily life 22 of the 28 patients alive at discharge were almost independent. At the time of the follow-up evaluation 17 of the 31 patients had died. For several reasons only 8 patients could be included in the follow-up, 6 vascular amputees and 2 traumatic amputees.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1999

Bilateral lower limb amputations as a result of landmine injuries.

Landmine explosions cause most of the war injuries in the battlefield. Amputations resulting from severe injuries reveal serious problems despite the improvements in surgery. Bilateral lower limb amputations have more impact than unilateral on social life. Some 29 cases with lower limb amputations due to landmine injuries were treated in the Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy between January 1992 and December 1996. Amputation levels were as follows: 1 case had hip disarticulation and a trans-femoral amputation, 6 had bilateral trans-femoral amputations, 6 had trans-femoral and trans-tibial amputations, 12 had bilateral trans-tibial amputations, 1 had trans-femoral and Chopart amputations and the remaining 3 cases had trans-tibial and Chopart amputations. The initial treatment was done for all cases in the first 6-8 hours after injury at the field hospitals. Aggressive debridement, excision and primary closure were performed. None of the stumps required reamputations and/or revision. No case had gas gangrene or tetanus. Postoperative, pre-prosthetic training programme which ranged between 30-120 days with an average 48 days; and prosthesis fitting and adequate post-prosthetic training programme which ranged 32-126 (average 94) days was applied. All the cases were followed-up with a mean of 38.5 months (14-72 months). Nine (9) cases (31%) returned to their previous occupation, while 20 (69%) cases had to change their jobs.

Adult↗
PubMed1978

Intracardial arteriographic study on vascular changes in amputated rabbits.

The vascular changes in rabbits after amputation were studied in vivo with arteriography, after intracardial injection of contrast. In the amputated extremity an initial vasoconstriction of the arteries was found. Thereafter changes were observed in arteries and veins, both in the operated and contralateral extremities, depending on the level of amputation and the manner in which the stump was closed. After amputation distally on the extremity and after stump closure without myoplasty arteriovenous shunting was observed in the amputation stump. Arteriovenous shunts were not seen after knee disarticulation and after proximal amputation on crus with myoplasty. Inactivity of the muscles in the amputation stump is supposed to be the cause of the shunt formation. After mid-femur amputation a permanent vasoconstriction of the femoral artery was observed, whereas artery dilation was seen when amputation on the femur was combined with plugging of the medullary cavity.

Amputation, Surgical↗
PubMed1980

Total femur replacement in sarcoma of the distal end of the femur.

Five patients with sarcoma of the distal end of the femur were treated by a total resection of the femur and its replacement by an endoprosthesis. This was to preserve the body image, prevent mutilation and permit independent ambulation. A chemotherapy program was established with administration of a high dose of methotrexate plus citovorum factor, adriamycin and vincristine. surgical removal of pulmonary metastases and other local recurrences was performed where and when possible. The functional results were excellent in four and poor in the remaining patient. All of the patients rapidly achieved physical rehabilitation and developed a stable and painless gait. This approach to the treatment of osteogenic sarcoma attempts to eliminate the primary tumor, the micrometastases and the overt metastatic disease, leaving the patient to follow as normal a life a possible, which is not the case when a high thigh amputation or a hip disarticulation is performed.

Adult↗
PubMed1983

Amputation for tumor of the upper arm.

In a 10-year period 35 patients underwent a proximal amputation of the upper limb because of a malignant tumor. In 27 patients a forequarter amputation was made, in one a humeroscapular disarticulation and in seven an amputation through the humerus. The observed 5-year survival was 23 per cent. Twelve out of 23 patients followed for at least 3 years also survived 3 years. Fifteen living patients were questioned concerning prosthetic use and social and psychologic factors. Only three patients used a functional (mechanical) prosthesis and only five used a cosmetic prosthesis. The other seven patients rejected the use of a prosthesis. Half of the patients had the same occupation postoperatively as preoperatively. Activities of daily living did not constitute any major problem. One of three housekeepers needed daily help. One patient seemed to have suffered obvious psychologic damage.

Adolescent↗
PubMed2003

In vitro biomechanical comparison of pedicle screws, sublaminar hooks, and sublaminar cables.

OBJECT: Three types of posterior thoracolumbar implants are in use today: pedicle screws, sublaminar titaniumcables, and sublaminar hooks. The authors conducted a biomechanical comparison of these three implants in human cadaveric spines. METHODS: Spine specimens (T5-12) were harvested, radiographically assessed for fractures or metastases, and their bone mineral density (BMD) was measured. Individual vertebrae were disarticulated and fitted with either pedicle screws, sublaminar cables, or bilateral claw hooks. The longitudinal component of each construct consisted of bilateral 10-cm rods connected with two cross-connectors. The vertebral body was embedded in cement, and the rods were affixed to a ball-and-socket apparatus for the application of a distraction force. The authors analyzed 1) 20 vertebrae implanted with screws; 2) 20 with hooks, and 3) 20 with cables. The maximum pullout (MPO) forces prior to failure (mean +/- standard deviation) for the screw, hook, and cable implants were 972 +/- 330, 802 +/- 356, and 654 +/- 248 N, respectively (p = 0.0375). Cables allowed significantly greater displacement (6.80 +/- 3.95 mm) prior to reaching the MPO force than hooks (3.73 +/- 1.42 mm) and screws (4.42 +/- 2.15 mm [p = 0.0108]). Eleven screw-implanted vertebrae failed because of screw pullout. All hook-and-cable-implanted vertebrae failed because of pedicle, middle column, or laminar fracture. CONCLUSIONS: These findings suggest that screws possess the greatest pullout strength of the three fixation systems. Sublaminar cables are the least rigid of the three. When screw failure occurred, the mechanism was generally screw back-out, without vertebral fractures.

Adult↗
PubMedDate not supplied

Endosporoideus gen. nov., a mitosporic fungus on Phoenix hanceana.

Endosporoideus pedicellata gen. et sp, nov. is described and illustrated from decaying petioles of Phoenix hanceana collected from grassland in Tai Mo Shan, Hong Kong. The genus is unique in producing solitary, phragmosporous conidia. The conidia comprise a brown to dark brown inner-wall layer and thick, hyaline outer-wall layer and are produced holoblastically from determinate conidiogenous cells on micronematous, mononematous conidiophores. Cells of conidia may disarticulate at the septa. Representative steps in conidiogenesis of E. pedicellata are illustrated with light micrographs, and details of the conidiogenous events are interpreted schematically.

Arecaceae↗
PubMedDate not supplied

The genus Podocrella and its nematode-killing anamorph Harposporium.

Several genera are described in the literature as having morphology similar to the clavicipitaceous genus Podocrella, viz. Atricordyceps, Ophiocordyceps, Wakefieldiomyces and "Cordyceps" peltata. These genera have capitate-stipitate stromata that gradually expand into a horizontally flattened fertile head that is dark, has strongly protruding perithecia and asci containing eight multiseptate filiform ascospores. These ascospores disarticulate at the middle septum to form two lanceolate multiseptate part-as-cospores. In this study several specimens of the above-mentioned genera, including the types, were examined to determine whether they are congeneric with Podocrella. This study also reveals the connection of Podocrella to its anamorph genus, Harposporium, and its relationship to several other clavicipitaceous genera, based on cultural data and large subunit nuclear ribosomal DNA (LSU) sequences. Nematode predation of the Harposporium anamorph of P. peltata is demonstrated. The results show Podocrella and selected Harposporium LSU sequences form a monophyletic group and that this clade is closely related to Aschersonia. A new species of Podocrella from Costa Rica, P fusca, is described, new combinations made for P. peltata and P. harposporifera, and a key to the known species is presented.

Animals↗
PubMed2005

An internet-based referral/consultation system for the U.S.-associated Pacific Islands: its contribution to orthopedic graduate medical education at Tripler Army Medical Center.

To evaluate the benefit of the Pacific Island Health Care Project (PIHCP) to our orthopedic graduate medical education program, we performed a retrospective review of our 8-year operative experience with patients referred through this program. Between July 1994 and June 2002, 69 patients underwent 79 orthopedic operative procedures. Patients were categorized by primary diagnosis, anatomic site involved, and surgical treatment rendered. Because many of the patients referred from the PIHCP with tumors were noted to have either unusually large lesions or advanced-stage disease, further analyses of tumor stage and pathologic grade were made. Seven of the 14 oncologic cases surgically treated in our department in the past 8 years were referrals from the PIHCP. Unique operative procedures performed for these tumor patients included one forequarter amputation, one hip disarticulation, one hemipelvectomy, two partial scapulectomies, and one distal ulna excision. We conclude that the PIHCP referrals provide an important and relatively unique contribution to the clinical and operative experience of our orthopedic residents. These patients from the Pacific basin also enhance our orthopedic graduate medical education program by exposing our residents to the special socioeconomic and cultural issues related to caring for people from developing insular countries.

Adolescent↗
PubMed1989

Changes in limb volume during head-out water immersion in humans.

In order to investigate the contribution of fluid shift from the legs to immersion-induced diuresis, 7 normal and 2 legless (both legs disarticulated at the hip) individuals were tested to measure changes in leg volume (normal subjects) and urinary excretion of solutes and water during a 3-h head-out water immersion (HOI) in thermoneutral water (34.5 +/- 0.5 degrees C) with a 1-h control period before and after immersion. On a separate day, a 5-h time control (TC) experiment on the same subjects was carried out by having them sit in thermoneutral air (29 +/- 0.1 degrees C, relative humidity 60%). The leg volume decreased by 192 +/- 20 ml during the 3-h HOI, which accounted for 3.5% of the average leg volume of the preimmersion period. During TC, however, the leg volume increased by 110 ml in the same time course. An increase in urine volume and sodium excretion was observed during HOI in both normal (P less than 0.05) and legless subjects. Net urine volume induced by HOI (urine volume during HOI minus urine volume during corresponding TC) in normal subjects was 494 +/- 89 ml in 3 h, which was close to a calculated volume reduction of the lower extremities during HOI (508 +/- 53 ml). The average net urine volume during HOI in the legless subject was 183 +/- 48 ml/min. The above results may suggest that the increase in renal water output is largely accounted for by a fluid shift from the lower extremities during HOI, however, the fluid other than that from the extremities should be accounted for as the urine source.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging.

Magnetic resonance (MR) imaging with multiaxial cross sections has been used to improve the resolution of small, fine, and slender spinal roots to more precisely diagnose herniated intervertebral disc (HIVD), especially in cases of far lateral disc (FLD) herniation. However, false-negative results remain a problem because of the unsatisfactory resolution of these methods. We report the use of a volume visualization technique to generate three-dimensional (3D) images from multiaxial sections. In our study, 10 patients with FLD herniation each underwent MR imaging (method 1), 3D MR image reconstruction with single-axis cross-sections (method 2), and 3D MR image reconstruction with multiaxial cross sections (method 3). Final diagnoses were confirmed at surgery. The preoperative diagnosis matched the operative findings in five patients using method 1, six patients using method 2, and nine patients using method 3. In addition, the software developed for this application includes functions which simulate decompression of the spinal cord and roots. Therefore, this computer-aided diagnosis system using multiaxial cross sections is a useful tool for diagnosing HIVD and for training medical residents and students. This technique has three main advantages over conventional imaging modalities: 1) resolution of small, fine, or slender anatomic structures, which reduces the possibility of false-positive and false-negative image findings; 2) segmentation (disarticulation) of images; and 3) simulation of surgery.

Adult↗
PubMed1999

[Amputation due to chronic peripheral vascular disease. Risks and prognosis].

A series of 181 amputations in 156 patients treated between 1985 and 1996 because of chronic peripheral vascular disease was reviewed. 107 major amputations (above- and below-knee) and 74 minor amputations (foot and forefoot) were performed. 81% of the patient population had previous vascular operations. Complications, revisions and mortality of all patients were retrospectively analyzed. The operative mortality rate of major amputations was 20% and the operative mortality rate of minor amputations was 9%. By a vessel-reconstruction before amputation the complication- (wound healing) and revision-rate could be reduced. By examination of the family-doctors, the survival times of the patients and the rehabilitation status of 69 living patients were recorded. Minor amputations, below-knee amputations and knee-disarticulations had the best results of rehabilitation.

Adult↗
PubMed1999

Surgical correction of polydactyly in a camel (Camelus dromedarius).

A 2-mo-old, 90-kg, intact male camel (Camelus dromedarius) was admitted for surgical removal of a supernumerary digit associated with the medial aspect of the right carpus and metacarpus. Radiographic views of the carpus and metacarpus revealed the supernumerary digit articulating with the middle carpal joint via an extra carpal bone. The supernumerary digit consisted of three bones. Surgical removal of the supernumerary digit was recommended to restore normal limb conformation, limit the possibility of future lameness, and improve the cosmetic appearance of the limb. Complete surgical removal of the digit was performed by disarticulating the extra carpal bone from its attachments to the second and radial carpal bones. One year after surgery, the leg appeared grossly normal and the camel showed no sign of lameness.

Animals↗
PubMed1999

[Chondrosarcoma secondary to multiple cartilage diseases. Study of 29 clinical cases and review of the literature].

PURPOSE OF THE STUDY: Several studies have demonstrated better prognosis of chondrosarcomas arising in hereditary multiple exostosis or Ollier's disease. The aim of this study was to evaluate their clinical, radiological and histological features and compare their prognosis with other chondrosarcomas. MATERIAL AND METHODS: We reviewed twenty nine secondary chondrosarcomas among seventeen patients with osteochondroma (group A), and eight with Ollier's disease (group B). These tumors represented 12 p. 100 of all chondrosarcomas treated between 1950 and 1994 in Cochin Hospital. Two group B patients successively developed three multicentric chondrosarcomas. Twenty six resections (eight intra and eighteen extra-lesional), two disarticulations and one amputation were performed as primary treatment. The average follow-up of the study was 10.5 years. The results were evaluated by means of survival curves. The significance of the difference between the curves was determined by the log-rank test. RESULTS: The mean age of malignant change was 36 years old. The most frequent tumoral site was the innominate bone for group A and the femur for group B. In three cases, radiographs showed no malignant features. All chondrosarcomas were classified as grade 1 or 2. The ten-year survival rate was 82 p. 100 with no significant difference between the two groups. The survival rates were significantly different after carcinologic surgery (extra-lesional resection or amputation) and contaminated surgery (intralesional resection), with 5 and 88 p. 100 of local recurrences respectively. DISCUSSION AND CONCLUSION: These secondary chondrosarcomas represent about 10 p. 100 of all chondrosarcomas. They appear 15 years earlier. According to O'Neal and Ackerman classification, most of the tumors are well-differentiated (60 p. 100 grade I, 39 p. 100 grade II and 1 p. 100 grade III). Carcinologic surgery is generally curative. Ten-year survival rate is 94 p. 100. With equivalent grade and surgery, their prognosis is better as compared to primary chondrosarcomas.

Adult↗
PubMed1999

A multidisciplinary, therapy-based, team approach for efficient and effective wound healing: a retrospective study.

This paper presents a 4-year retrospective study (1994 to 1998) of therapy-based treatment outcomes for chronic wounds of all stages and most common etiologies. Treatment in this study consists of outpatient wound treatments given by trained therapists and nurses who were supervised by the podiatrist or internist. Many patients were referred to the clinic for last-resort treatment (i.e., electrical stimulation, topical hyperbaric therapy, etc.) before major lower extremity amputations: hip disarticulation, above knee amputation (AKA), below-knee amputation (BKA). This study does not consider age, sex, chronicity, or ethnicity because the authors want to demonstrate the effectiveness of this treatment approach for healing chronic wounds notwithstanding these variables. Wound healing was achieved in 100% of patients who completed their treatment program (233 patients with 242 wounds). This study shows the total average healing time for wounds is 7 weeks for Stage II wounds, 10 weeks for Stage III wounds, and 19 weeks for Stage IV wounds. The average healing time for diabetic wounds is 14 weeks (wounds of neuropathic origin heal in 12 weeks and wounds of ischemic origin heal in 16 weeks). The average healing time for venous stasis wounds is 8 weeks. The study includes patients with ischemia who are not candidates for revascularization. The authors assert that the most effective treatment for wound healing is a therapy-based, multidisciplinary team approach. This retrospective study shows that the goal of complete healing is attainable.

Ambulatory Care↗