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PubMed2004

Modified supracondylar amputation of the femur.

The upper leg can be amputated at many levels starting with the through the knee amputation and ending with the hip disarticulation. The most common above the knee amputation is through the mid-femur, and this procedure is taught in most surgical programs in the United States. A new modification of the supracondylar amputation of the femur is herein described. A 20-year experience of over 200 procedures is reported using a new modification of the supracondylar amputation of the leg. Two deaths occurred, and a primary healing rate of 95 per cent was obtained. Revision to a higher level was required in only three patients. The advantages of the modified amputation procedure include short operative procedure, minimal blood loss, long femur stump, reduced pain, strong fascial closure, high rate of primary healing, and avoidance of a postoperative flexion contracture at the hip.

Amputation, Surgical↗
PubMed2004

[Necrotizing fasciitis in the lower extremity secondary to diabetic wounds].

OBJECTIVES: The aim of this retrospective study was to evaluate patients who developed necrotizing fasciitis (NF) in the lower extremity secondary to diabetic wounds. METHODS: The study included sixteen patients (11 men, 5 women; mean age 63 years; range 50 to 82 years) who were treated for NF arising from diabetic wounds. Associated diseases were coronary heart disease in three patients, and chronic renal failure due to diabetic nephropathy in three patients. The patients were evaluated by physical examination, direct radiographs, blood pressure measurements, and cultures, and with respect to treatment methods and results. The mean hospitalization period was 26 days (range 5 to 59 days). RESULTS: Necrotizing fasciitis was confined to the leg in four patients, extended to the thigh in 10 patients, and was bilateral in two patients. Pain was encountered in 10 patients (68.8%). Fourteen patients (87.5%) had increased creatine kinase levels. Direct radiographs showed gas appearance in soft tissues in seven patients (43.8%). Cultures showed a single microorganism in four patients (25%), and multiple microorganisms in five patients (31.3%). Of seventeen microorganisms isolated, 10 (58.8%) were Enterobacter species. Eleven patients (68.8%) underwent above-the-knee, and three patients (18.8%) underwent below-the-knee amputations. Disarticulation of the hip was performed in four patients. The mean number of debridements was five (range 2 to 21) following the initial surgical intervention. Nine patients developed septic shock. Seven patients (43.8%) died due to multiple organ failure. Increased creatine kinase levels were significantly associated with mortality (p<0.05). CONCLUSION: Early and accurate diagnosis and prompt surgical treatment may be life-saving in diabetic patients with NF of the lower extremity.

Aged↗
PubMed2002

[Computerized tomographic evaluation of traumatic ossicles disruption].

OBJECTIVE: To investigate the importance of the high resolution computerized tomography of temporal bone in evaluation of traumatic lesions, particularly of the ossicular disruption. METHOD: Ten patients with traumatic ossicles dislocation underwent preoperative CT scanning followed by surgical exploration of the middle ear. RESULT: The radiographic finding was consistent with the operative demonstration for malleoincudal disarticulation (3 ears), incudostapedial dislocation (7 ears), and the fracture of temporal bone (8 ears). CONCLUSION: The incus was the most vulnerable ossicle in the trauma to the middle ear. CT scans can diagnose exactly the damage position in middle ear.

Adolescent↗
PubMedDate not supplied

Effects of ciprofloxacin on secondary ossification centers in juvenile Wistar albino rats.

BACKGROUND: Administration of quinolone therapy is controversial during juvenile age as stated by earlier workers. The fluroquinolones are currently not indicated for young children, because of the arthropathy and adverse effect on growing cartilage shown by studies. However the effects of ciprofloxacin on secondary ossification centers has remained undocumented. This study is therefore aimed to determine the risk of Ciprofloxacin administration on neonatal skeletal differentiation by a prospective and comparative animal study model using Wistar albino rats. METHODS: Ciprofloxacin was administered to newly born Wistar albino rat pups at a dose of 20 mg/kg body weight intraperitoneally twice daily from day-1 to day-14 after birth. These animals were killed by deep ether anaesthesia and fixed in 80% alcohol. They were then bulk stained with Alizarin red and Alcian blue. Finally they were cleared in 4% KOH and stored in glycerin. The fore and hind limbs were disarticulated from the axial skeleton and observed under stereomicroscope for evidence of skeletal differentiation in the form of presence of secondary ossification centers in long hones (left humerus and left femur). The time of appearance of these centers were noted and compared statistically with those in control animals. RESULTS: The study revealed that the skeletal differentiation in long bones was delayed by 2.4 +/- 0.2 days at both proximal and distal ends in humerus and 2.4 +/- 0.2 days at proximal end and 2.2 +/- 0.2 days at distal end of femur in experimental animals as compared with controls. CONCLUSION: The ciprofloxacin administration during post-natally presents a risk to skeletal differentiation and therefore to its growth up to the age of six weeks is albino rate pups.

Animals↗
PubMed2004

The sequence in appearance and disappearance of impressiones gyrorum cerebri and cerebelli.

We investigated the sequence and the intensity in the appearance and the disappearance of the impressiones gyrorum cerebri and cerebelli, of juga cerebralia and cerebellaria and of juga cerebellaria interlobularia in the collection of 34 macerated and disarticulated skull bones from the newborn to 30 years of age (68 specimens/halves of skulls) and 19 skulls in the period from 30 to 80 years of age (38 specimens). Juga cerebralia on the squama of the temporal bone and cerebral lamina of the frontal bone appeared already in the course of the first year of life, much earlier than cited in the literature. The intensity of the development of juga cerebralia increased to the third decade. After that age, the intensity decreased gradually, and the juga cerebralia disappeared completely in parietal bones, in the cerebral fossae of the occipital bones and finally in most cases also on the cerebral lamina of the frontal bones. Juga cerebellaria and impressiones gyrorum cerebelli appeared in the middle of the second year of age and persisted to the ten years of age, which coincides with the closure of the fissures among the parts of the occipital bone. Jugum cerebellare intersemilunare appeared in the first year of life and persisted in its complete length, or interrupted in different sections of its course, during the whole life. The intensity in appearance of juga is partly influenced by the increasing thickness of the diploe.

Adult↗
PubMed2005

Inheritance of seed dormancy in Tibetan semi-wild wheat accession Q1028.

Tibetan semi-wild wheat (Triticum aestivum ssp. tibetanum Shao) is one of the Chinese endemic hexaploid wheat genetic resources, distributed only in the Qinghai-Xizang Plateau of China. It has special characters, such as a hulled glume and spike disarticulation. However, seed dormancy, another important character for wheat resistance to pre-harvest sprouting, was rarely reported. Seed dormancy of more than 10 Tibetan semi-wild wheat accessions was evaluated, and their germinations were 0% or near 0% with both treatments of threshed seeds and intact spikes at hard dough stage. Tibetan semi-wild wheat accession Q1028 was investigated for its seed dormant characters by testing the seed germination percentages of intact spikes, seeds with bract powder, normal seeds, seeds with pierced coat, and sectioned embryos. It was observed that embryo dormancy of Q1028 accounted for its seed dormancy. Using threshed seeds and intact spikes at hard dough stage, the inheritance of seed dormancy was carried out using the F1, F2, F3 and F2BC1 populations of the cross between Q1028 and a wheat line 88-1643, susceptible to preharvest sprouting. The germinations of seeds and intact spikes in F1 plants were 1.0% and 0.9%, respectively. It indicated that seed dormancy of Q1028 was inherited as a dominant trait. From the genetic analysis of the F2, F3 and F2BC1 populations it was found that the strong seed dormancy of Q1028 was controlled by two dominant genes.

Adaptation, Physiological↗
PubMed2005

Effective maxillary orthopedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis.

The effective maxillary orthopedic protraction is an innovative technique for maxillary protraction in Class III growing patients. It includes three components: a new 2-hinged rapid maxillary expander for a greater amount of anterior displacement of maxilla, repetitive weekly protocol of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) for disarticulating the maxilla, and intraoral maxillary protraction springs for non-compliant protraction. On average, the maxilla could be protracted for 5.8 mm in 3 months and the result remains stable at least 2 years later. The rationale for this technique is sutural expansion/ protraction osteogenesis. Sutural expansion/ protraction osteogenesis is a form of distraction osteogenesis. However, it still needs to be scrutinized experimentally for the sutural reactions corresponding to the effective maxillary orthopedic protraction.

Humans↗
PubMed2006

Osteosarcoma among children aged 5 years or younger: the St. Jude Children's Research Hospital experience.

Osteosarcoma primarily affects adolescents. The authors reviewed the records of eight patients aged 5 years or younger (of 470 patients with osteosarcoma) treated at their institution. Tumors (seven of high grade and one of low grade) arose mostly in the appendicular skeleton; one patient had metastases. One patient with low-grade osteosarcoma survived after surgery alone. Two with active disease died of chemotherapy toxicity. The remaining five (three received chemotherapy) underwent surgery and are long-term survivors. Two who underwent hemipelvectomy or hip disarticulation would likely have undergone limb-sparing surgery today. These findings and a review of the similar cases in the literature suggest that osteosarcoma's clinical characteristics are similar among young children and older children.

Age Factors↗
PubMedDate not supplied

[Lower limb amputations caused by tumours and prosthetic rehabilitation in Croatia from 2000 to 2004].

During the period of five years (2000-2004) we monitored 46 patients (25 males and 21 females) who were admitted to Clinical Institute for Rehabilitation and Orthopaedic Aids in Zagreb for the first prosthetic rehabilitation following the lower limb amputation which was caused by a tumour. The average age of patients was 51 +/- 17.11 years. According to the pathohistological diagnosis the most common cause of lower limb amputations was osteosarcoma. According to the level of amputation the most frequent was trans-femoral amputation (50%) and the least frequent was knee disarticulation (8.7%). The average number of days from the amputation to the beginning of prosthetic rehabilitation was 108 +/- 67.05. At the time of admission 15.2% of patients had local complications of the stump and 34.8% of patients complained of phantom pain. The average number of days of prosthetic rehabilitation was 35 +/- 7.94. The medium daily use of the prosthesis was 5 hours and the medium walking speed was 12 sec/10 m. At the time of admission for the prosthetic rehabilitation 10.9% of patients used a wheelchair, 8.7% walked with a walker and others with two crutches. At the time of discharge 89.1% of patients were able to walk with a prosthesis and two crutches, 4.4% with one crutch and 6.5% were able to walk without crutches. We can be satisfied with the results of prosthetic rehabilitation because patients regained mobility and full independence in performing their daily activities.

Adolescent↗
PubMed2006

Survival of an eight-year-old child with a very severe high-tension electrical burn injury: a case report.

We present the management and survival of an eight-year-old boy with a severe high-tension electrical burn injury of 68% of total body surface area in a surgical intensive care unit, as a result of a well-planned and applied treatment strategy. Subsequent to escharotomy and fasciotomy operations under general anesthesia, the patient was taken into the surgical intensive care unit. In addition, patient underwent nine more operations including right femur disarticulation and split-thickness skin graftings with homografts from his brother and autografts. The patient was connected to mechanical ventilator for 59 days. By the time the patient was transferred to plastic and reconstructive surgery ward, he was fully conscious, cooperated and hemodynamically stable.

Burns, Electric↗
PubMed2006

[Preliminary evaluation on seroma prevention and treatment with transposition of tissue flaps and arista hemostatic powder].

OBJECTIVE: To investigate and evaluate prevention and treatment of seroma by transposition of tissue flaps and Arista hemostatic powder after regional lymph node resection in patients with malignant tumors. METHODS: Twelve patients (6 males, 6 females; aged 31-81 years, with metastatic tumors underwent prevention and treatment of seroma with the tissue flaps and Arista hemostatic powder spray after regional lymph node resection. The metastatic tumors involved the axilla in 1 patient with breast carcinoma, the iliac and inguinal regions in 2 patients with carcinomas of the uterine cervix and the rectum, and the inguinal region in 9 patients, including 4 patients with malignant fibrous histiocytoma(3 in the thigh, 1 in the leg), 2 patients with squamous carcinomas in the leg, 1 patient with synovial sarcoma in the knee, 1 patient with epithelioid sarcoma in the leg, and 1 patient with malignant melanoma in the foot. As for the lymph node removal therapy. 1 patient underwent axillary lymph node removal, 2 patients underwent lymph node removal in theiliac and inguinal regions, and 9 patients underwent lymph node removal in the inguinal region. Meanwhile, of the 12 patients, 6 patients underwent transposition of sartorius flaps with Arista hemostatic powder, 3 patients underwent transposition of the rectus abdominis myocutaneous flaps (including 2 patients treated with Arista spray befor the wound closure and 1 patient treated by transposition of local skin flaps with Arista spray used again),and 3 patients underwent only the suturing of the wounds combined with Arista. At the same time, of the 12 patients,only 4 patient underwent the transplantation of artificial blood vessels. RESULTS: The follow-up for 2-10 months after operation revealed that 10 patients, who had received the transposition of tissue flaps and the spray of Arista hemostatic powder, had the first intention of the incision heal with seroma cured. Nine patients were given a preventive use of Arista hemostatic powder and therefore no seroma developed. The combined use of the transposition of tissue flaps and Arista hemostatic powder spray achieved a success rate of 100% in the prevention or treatment of seroma. However, 1 patient developed microcirculation disturbance 24 hours after operation and underwent disarticulation of the hip; 1 patient developed pelvic cavity hydrops and died 10 months after operation. CONCLUSION: The combined use of transposition of tissue flaps and Arista hemostatic powder spray can effectively prevent or treat seroma after regional lymph node removal in a patient with malignant tumor.

Adult↗
PubMed1991

Infections at the site of a hip implant. Successful and unsuccessful management.

Thirty-four patients developed the complication of deep infection at the site of a hip implant (n = 35). Multiple factors in existence at the time of implant placement and the time of presentation with infection as well as the therapeutic regimen were retrospectively analyzed. Patients with successful outcomes (n = 15) were relatively younger (mean, 52 years) compared to those that had an unsuccessful outcome (n = 19; mean, 65 years; p less than 0.01). No other factors were predictive of the outcome of treatment. Implant extirpation, expedient wound closure, and, when necessary, muscle transposition favored a successful outcome. Implant retention and open wound packing resulted in prolonged wound healing and, sometimes, hip disarticulation or death.

Adult↗
PubMedDate not supplied

Congenital absence of the lumbar spine and sacrum: one-stage reconstruction with subsequent two-stage spine lengthening.

This is a case report of a child born with severe, type IV lumbosacral agenesis. At age 6 years, she had surgical reconstruction of her absent spine and thoracic-pelvic instability with Harrington rods and autogenous bone obtained from simultaneous bilateral knee disarticulations. This arthrodesis healed solidly, and at the age of 10 years 6 months and again at age 12 years 6 months, she underwent spine lengthening by osteotomy and distraction instrumentation, the first time with Moe rods and the second time with Cotrel-Dubousset rods. Both lengthening osteotomies healed without difficulty. The spine lengthening achieved was 5.0 cm.

Bone Lengthening↗
PubMed1991

The effect of post space preparation on the apical seal of root canal obturated teeth.

The dental literature is contradictory about the quality of the apical seal as it relates to the length of remaining gutta-percha following post-space preparation. The purpose of this study was to compare apical leakage with varying remaining lengths of gutta-percha in an in vitro system. Fifty disarticulated single canal human mandibular premolar teeth were used in five experimental groups. All root canals were prepared 1 mm short of the apical foramen through a size 50 k-file and sequentially flared through a size 70 k-file. Four groups were obturated using gutta-percha with lateral condensation and Roth's 801 Elite Grade root canal sealer. Post-space preparation was accomplished by removing gutta-percha with heated pluggers so that the lengths of the remaining filling varied by increments of one millimeter between 3 and 7 mm. Specimens were covered with enamel paint leaving only the apical foramen exposed. All roots were then submerged in 1 percent methylene blue dye for two weeks, sectioned longitudinally, and measured for depth of dye penetration. No significant difference was found between the 4 and 5 mm groups or between the 6 and 7 mm groups. Significant difference (p less than .05) in leakage did exist between the 3, 4-5, and 6-7 mm groups, showing the least in the latter groups. The best apical seal was obtained when the maximum of 6 mm of gutta-percha remained.

Analysis of Variance↗
PubMed1991

An experimental field protocol for investigating the postmortem interval using multidisciplinary indicators.

This article proposes an experimental field protocol for investigating the postmortem interval using specially designed apparatus and human and pig cadavers. We further propose that this goal can only be achieved by a multidisciplinary group, comprised of forensic entomologists, pathologists, and anthropologists. The apparatus and collecting methods described by the authors establish the means by which data can be collected on several fronts simultaneously: the sequential arrival and variety of insects in the decay process, the character and manner of soft tissue decomposition, the sequence and nature of bone exposure and order of disarticulation of skeletal remains, and the influence of climate and season on decay rates and arthropod succession. A central feature of this protocol involves the construction and use of a dual-functioning insect trap that allows separate but simultaneous capture of arriving and emerging populations while successional and decompositional processes of the cadaver are left intact. Results of trap performance tests in an arid climate and preliminary arthropod data collected from field-exposed pig carcasses are presented. The use of this protocol could provide important and badly needed baseline data for both medical investigators and law enforcement personnel, information that is critical to understanding the causes, manner, and time of death, which the law requires to be ascertained.

Animals↗
PubMed1991

Treatment of pathologic fracture of the humerus.

Twenty-one patients with 22 pathologic humeral fractures were seen between January 1977 and November 1988. All fractures were secondary to myeloma or metastatic disease. Primary bone tumors were not included. Nineteen of 22 fractures were treated with intramedullary fixation: 12 of these fractures were also treated with methylmethacrylate. Two patients had compression plating, and the remaining patient had no surgery. Twenty-eight percent had a previously undiagnosed malignancy. Postoperatively, 78% of the patients had only mild or moderate pain. Five patients had progression of local disease postoperatively, two resulting in failure of fixation. Both plates failed. Three patients required additional humeral procedures, one of which was a shoulder disarticulation for pain. Intramedullary fixation of pathologic fractures improves the quality of life by controlling pain for most patients. Complications, treatment failures, and pain are related to a 29% rate of tumor progression and a 23% rate of fixation failure.

Adult↗
PubMed1979

Locally aggressive fibrous histiocytoma of bone. A case report.

A fibrohistiocytic tumour involving the distal diaphysis of the left femur in a 44-year-old woman is described. The lesion had a completely benign appearance cytologically but behaved in a locally aggressive manner in that it eroded the adjacent cortical bone and even extended into the soft tissue. To the best of our knowledge, no other similar case has been documented. A lesion of the humerus has been described as an atypical fibrous histiocytoma on the basis of prominent nuclear pleomorphism; the patient involved was alive 5 years after a disarticulation. The differential diagnosis of such a locally aggressive fibrous histiocytoma of bone would include a metaphyseal fibrous defect, benign fibroxanthoma, and malignant fibrous histiocytoma. We believe that the differentiation of a locally aggressive fibrous histiocytoma from the malignant variety may be important in view of the probable differing therapeutic and prognostic implications.

Adult↗
PubMed1990

[Current status of amputation surgery].

Limb salvage by revascularisation of occluded arterial pathways is main goal of vascular surgical activities. However, if dying or gangrenous tissue has to be removed, the question of: where to amputate--and the potential rehabilitation has to be answered. Septic amputation being an emergency operation has to be compared with elective one with definitive shaping of the stump. In major amputations knee disarticulation is preferred nowadays as being mostly "atraumatic" and well able for rehabilitation. In minor amputations bunions of the great and the little toes should be preserved especially in case the whole phalangeal and metatarsal forefoot amputation seems to have better results than removal of the first of fifth toe together with their metatarsia. A distal borderline amputation can only be performed in diabetics and after revascularisation of the feeding arterial tree.

Amputation, Surgical↗