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At least 775 records · Page 43Linked to original sources
PubMed2005

[Repair of defects at both ends of blood vessels in extremities with a great disparity in diameter by vein transplantation].

OBJECTIVE: To repair defects at both ends of the blood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. METHODS: Three kinds of phleboplasty: funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins, small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation. The length of The phleboplasty of funnel-shaped could enlarge the grafted blood vessels ranged from 1.0 cm to 15.0 cm. RESULTS: The phleboplasty of funnel-shaped could enlarge the diameter by 1.0-1.25 times in anastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In 36 grafted veins, 35 were in patency. The blood supply in extremities was normal. CONCLUSION: The funnel-shaped and raincape-shaped phleboplasty of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primary blood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.

Adolescent↗
PubMed2005

An unusual solution after bilateral lower extremity amputation.

The authors present a case of a 40-year-old male with devastating amputation trauma of both lower extremities. Reconstruction of the right lower extremity was solved by the unusual use of inserted vascularized bone-skin graft from the left crus with a simultaneous replantation of the right foot. The result after 3.5 years is preservation of one extremity with full knee mobility. The other lower extremity was fitted for thigh prosthesis.

Adult↗
PubMed2006

War injuries of the extremities: twelve-year follow-up data.

BACKGROUND: More than 75% of all injuries in modern wars are injuries of the extremities, usually with highly contaminated wounds and major soft tissue destruction. In this review, we present the late functional results for 35 of 41 wounded patients who sustained solitary war injuries of the extremities with open fractures. METHODS: During a 6-month period from August 1991 to February 1992, of a total of 1,050 injured patients, 49 wounded patients with isolated open fractures of the extremities were treated in General Hospital Nova Gradiska (Nova Gradiska, Croatia). The mean age was 34 years (range, 17-85 years); 44 wounded patients (90%) were male and 37 (76%) were soldiers. With primary amputations for 8 (16%) of 49 injured patients, external fixation was performed for 27 wounded patients (66%); primary internal fixation was applied for eight wounded patients (19.5%). After 12 years, 35 (85%) of the injured patients were available for evaluation concerning (a) fractured bone nonunion, (b) osteomyelitis, (c) late amputation, (d) nerve palsy, and (e) function. RESULTS: Osteomyelitis occurred for five patients (12%), only one with primary external fixation. In two cases of delayed conversion of external fixation to internal fixation, osteomyelitis occurred, requiring external fixator restoration. This has been no recurrence of osteomyelitis in the past 5 years and, after 12 years, more than three-fourths of wounded patients showed no or mild reduction of function of related proximal and distal joints. According to Index of Independence in Activities of Daily Living scores, grade B was found for only two wounded patients, with grade A for the others. CONCLUSION: The application of external fixation is the first and definitive choice of treatment for war-related open fractures of extremities, producing good late functional results. Conversion of external fixation to internal fixation leads to osteomyelitis, demanding another operation and application of secondary external fixation.

Adolescent↗
PubMed2006

[Experimental support for the application of plasma streams in the treatment of gunshot wounds of extremities].

Experimental data on the application of plasma streams (PS) for the treatment of gunshot wounds of extremities is presented. On the basis of the investigated material (20 animals in which treatment included PS compared to 10 animals where treatment was carried out without SP application) it was established, that bullet wounds of extremities are cleared of pathogenic microflora in shorter terms, the expressed anesthetizing effect was observed, basic function of finiteness was restored 4 - 5 days earlier. The common reduction of time parameters was in average 22 - 25%. By all parameters results of the treatment in the group with PS application were much better, especially by such criteria, as frequency of purulent complications in the early postoperative period and reliability of the hemostasis. The opportunity of application of PS is authentically proved at operations on extremities, including those with the damage of bone structures, nervous trunks, at amputations, at purulent complications, i.e. practically at all possible variants of the damage of extremities and their consequences.

Humans↗
PubMed2006

[Advance in management of skeletal trauma of the extremities].

OBJECTIVE: To investigate the advance in the management of skeletal trauma of the extremities. METHODS: The literature at home and abroad was reviewed, and the research findigs with clinical experience in the therapeutic methods for fracture of the extremities were summarized. RESULTS: The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computer-assisted surgery was applied, and the tissue engineering was developed. The fracture management was changed from tubular bone, the boanatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery, and computer-assisted surgery. In concordance with the MIS principles, the new implants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or non-union of fractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bone transport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality. CONCLUSION: Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency in this field.

Extremities↗
PubMedDate not supplied

Table-moving contrast-enhanced magnetic resonance angiography in the evaluation of lower extremity peripheral arterial bypass grafts.

The aim of this study was to investigate the utility of table-moving contrast-enhanced three-dimensional MR angiography in the evaluation of lower extremity peripheral arterial bypass grafts. Twenty-two lower extremity peripheral arterial grafts (13 autologous saphenous vein, 7 polytetrafluoroethylene and 2 Dacron) in 18 patients were evaluated. Preoperative diagnosis were occlusive arterial segments in 14 cases, 4 aneurysms in 2 cases (3 aneurysms in one case) and traumatic femoral artery injury in 2 cases. 1.5T superconductive magnet was used with torso-phase and whole body coil system on MRI examinations. Lower extremity peripheral arterial grafts were evaluated and anastomosis sites were classified into five groups as normal, insignificant stenosis (< 50%), significant stenosis (> 50%), occlusion and ectatic or aneurysmatic appearance. Contrast-enhanced MR angiography imaging of 66 segments of 22 graft patients were of high quality. No difficulties were confronted in the radiological evaluation of peripheral bypass grafts. Graft stenosis as detected in five grafts. Stenotic segments were at the proximal (n = 4) and distal (n = 3) anastomosis sites. Total occlusion was shown in three grafts. Ectasia or aneurysm was seen in only one graft. In lower extremity peripheral bypass graft patients, table-moving contrast enhanced MR angiography can be used in the evaluation and follow-up of the vascular lesions.

Arterial Occlusive Diseases↗
PubMed2006

The effect of positioning for children with cerebral palsy on upper-extremity function: a review of the evidence.

CONTEXT: Controversy exists about the most appropriate seating position for children with cerebral palsy (CP) to promote energy conservation and maximize upper-extremity function. EVIDENCE ACQUISITION: Sixteen journal articles published after 1980 were identified by searching allied health, medical, and occupational and physical therapy data bases and evidence-based medicine reviews using specific key terms (positioning, wheelchair, postural control, posture, adaptive seating devices, patient positioning, cerebral palsy, movement disorders, upper extremity, reaching, grasping, and occupational therapy) and reviewing bibliographies of retrieved articles. EVIDENCE SYNTHESIS: The majority of the evidence supports the positive effects of a neutral to slightly forward orientation (whole chair tilted) on upper-extremity function. Only one study did not demonstrate such effects. Of the supporting studies, one suggested the addition of an abduction orthrosis (AO), one recommended the entire functional sitting position (FSP) package (this orientation plus a hip-belt, footrests, AO, and cutout tray), and one established the long-term effects of the FSP. One less rigorous study opposed the addition of an AO. With the exception of one study, most of the evidence states that seat angle does not affect functional abilities. However, some of these studies contain faulty methodology and/or their results demonstrate clinical significance. CONCLUSION: Evidence supports that children with CP should be fitted for wheelchairs that place them in a FSP, which includes; orientation in space of 0 degrees -15 degrees, a hip-belt, an AO, footrests, and a cutout tray, with the addition of a sloped forward seat of 0 degrees -15 degrees, to improve upper-extremity function. The exact seat angle and orientation in space within the 0 degrees -15 degrees range should be determined on an individual basis.

Activities of Daily Living↗
PubMed2006

[Effects of lower extremity joints' disease on lumbar surgical outcomes].

OBJECTIVE: To study the effects of lumber operation on patients with pathologic changes of the lumbar vertebrae combined with degenerative diseases of lower extremity joints. METHODS: 237 patients with pathologic changes of the lumbar vertebrae combined with pain and/or limited activity of hip or knee joint, 153 (64.56%) with degenerative knee joints and 84 (35.44%) with degenerative hip joints received lumbar surgery. 160 patients with lower extremity joint pain and negative physical examination and imagology before the surgery were used as controls. The joint pain value was assessed on all patients with Visual Analog Scale before and after treatment and the joint pain relief rate was calculated. RESULTS: The average pain relief rate of the control group was 90.54%, significantly higher than those of the degenerative knee joint group (55.20%) and the degenerative hip joint group (46.88%, both P < 0.05). CONCLUSION: Diseases of lower extremity joints influence the lumbar surgical outcomes. It is very important to make a definite diagnosis of the lower extremity joint pain pre-operationally and take appropriate measures to treat the pain according to its pathogenesis.

Adult↗
PubMed2006

[Application of one-stage arteriovenous shunt to circulation reconstruction for extensive arterial ischemic disease of lower extremities].

OBJECTIVE: To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities. METHODS: The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases, including arterial occlusive disease (AODs, 62 patients) and thromboangiitis obliterans (TAOs,28 patients). By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients, the immediate and the long-term surgical outcomes were summarized. RESULTS: During the hospitalization, 88 patients achieved a remarkable surgical effectiveness, with an immediate surgical effectiveness rate of 97.7% (88/90), but 2 patients failed in the operation and had to undergo amputation of the lower limb. Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation, 64 could have a sufficient blood supply to the lower extremities, with a long-term effectiveness rate of 88.9% (64/72); however, 8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb. CONCLUSION: The one-stage arteriovenous shunt performed on the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.

Adult↗
PubMed1989

Importance of arterial, venous and arteriovenous values of ABB parameters and glucose metabolites for assessment of resting lower extremity metabolism in healthy individuals and in patients with peripheral arterial occlusive disease.

The study deals with assessment of the extent of tissue ischaemia and disorders of aerobic metabolism on the basis of comparison of resting arterial, venous values, and the arteriovenous differences in pH, pCO2, pO2, lactate, pyruvate and glucose levels and the lactate/pyruvate index in 32 extremities of 16 healthy individuals and in 42 extremities of 38 patients with chronic ischaemic syndrome of the lower extremity in stages IIb, III and IV according to Fontaine. The group of patients showed significantly higher values of lactate, pyruvate, glucose and the lactate/pyruvate index and lower pH levels than controls. Changes in pCO2, pO2 and pyruvate levels were not significant. Multivariate analysis of data revealed serious impairment of the metabolism of extremities affected by chronic ischaemia.

Arterial Occlusive Diseases↗
PubMed1988

Ultrasound of soft tissue abnormalities of the extremities.

Ultrasound may be the preferred initial diagnostic modality for the painful swollen extremity, the palpable extremity mass, and the injured extremity. The role of ultrasound in extremity soft tissue abnormalities, including muscle hemorrhage and injury, inflammatory processes, and soft tissue neoplasms, is the subject of this review.

Abscess↗
PubMed1981

[Regional perfusion of the extremity - experience in 81 patients with malignant melanomas (author's transl)].

From December 1978 through December 1980 a total of 81 patients with malignant melanoma of the extremities were treated by local excision, isolated regional hyperthermic perfusion and regional lymphadenectomy. The extracorporeal circuit was primed with 650 ml whole blood. Flow rates for the lower extremity were 494 +/- 38 ml/min. and 273 +/- 66 ml/min. For the upper extremity. The systemic pressure was 80 +/- 15 mm Hg. Limb temperatures were elevated to 42 degrees C. Intraoperatively there was one case of intima dissection, but no other serious complications. Post operatively one patient died one the 19th day due to congestive heart failure and in one patient a temporary loss of peroneal nerve function was noted. Delay in wound-healing was seen in five patients and 70 patients developed transitory erythema of the extremities. 75 patients are alive and free of disease. Of the 33 patients who underwent more than one operation prior to perfusion, six developed local recurrences or in-transit lesions.

Adult↗
PubMedDate not supplied

[Distribution of sensory fibers of the extremities in the neuropile of the abdominal chain of Eurygaster integriceps].

Sensory neuropile of the extremities has been studied in series sections and total preparations from E. integriceps. Extremity nuclei are fairly well distinguished from the rest neuropile. Only terminal sensitive fibers enter the nucleus through the sensory root of the nerve. The main bulk of fibers is divided into two branches. With respect to the branching pattern, terminal fibers of the insect studied are similar to typical fibers of the sensory neuropile in the dragonfly, locust, and cricket. It is suggested that the sensory neuropile of the extremities in all insects occupies the same position and is composed by similar nervous elements. Differences concern the extent of development and differentiation of the nuclei, being associated with peculiar functions of the extremities in the given insect.

Animals↗
PubMed1995

Prevalence and predictive value of ECG findings in acute extremity ischemia.

OBJECTIVE: To determine the prevalence and predictive value of ECG findings in patients treated surgically for acute extremity ischemia. EXPERIMENTAL DESIGN: Retrospective study with follow-up for one month. SETTING: Tampere University Hospital, Jyväskylä Central Hospital. PATIENTS: 114 patients with acute extremity ischemia treated surgically. INTERVENTIONS: Emergency thromboembolectomy was performed to all patients. MEASURES: ECGs, taken preoperatively at the emergency department, were analysed according to the Minnesota code. Death was regarded as the endpoint of the study. RESULTS: ST-J depression (60.5%) and T-wave inversion (71.9%) were the most common single findings. The ECG was considered suggestive of ischemic heart disease in 64.0% of patients. The prevalence of atrial fibrillation was 37.7%. Atrial fibrillation was found in 25.0% of patients with acute thrombotic occlusion and in 43.6% of patients with embolic occlusion (chi 2 = 3.6, df = 1, p = 0.057). The ECG was suggestive of ischemic heart disease in 87.5% of patients who died within a month compared to 60.2% in those still alive (chi 2 = 4.4, df = 1, p = 0.034). In logistic regression analysis atrial fibrillation was found to increase the risk of mortality (B = 0.93, df = 1, p = 0.002); odds ratio 2.6 (95% CI 1.4-4.7). CONCLUSION: Most patients with acute extremity ischemia had significant ECG findings with low prevalence of AF reflecting increased ratio of thrombotic occlusions. AF and ECG suggestive of ischemic heart disease were also associated to poor short-term prognosis. We think that acute thrombosis should be suspected in most patients with acute extremity ischemia.

Acute Disease↗
PubMed1997

Osteogenic sarcoma of the extremity with detectable lung metastases at presentation. Results of treatment of 23 patients with chemotherapy followed by simultaneous resection of primary and metastatic lesions.

BACKGROUND: In the past 20 years, it has been demonstrated that the combination of surgery and chemotherapy improves the prognosis for patients with osteosarcoma of the extremity without detectable metastases at presentation. By contrast, the efficacy of chemotherapy coupled with aggressive surgery has not yet been well established for patients with metastatic disease at diagnosis. The current study evaluates the efficacy of chemotherapy associated with simultaneous surgery of primary and metastatic lesions in patients presenting with osteosarcoma of the extremity with lung metastases. METHODS: Patients with lung metastases originating from an osteosarcoma of the extremity received chemotherapy (high dose methotrexate, cisplatin, doxorubicin, and ifosfamide) followed by simultaneous resection of primary and metastatic lesions and additional chemotherapy. RESULTS: Between January 1993 and June 1995, 23 patients entered the study. After primary chemotherapy, lung metastases disappeared in three patients, whereas in four patients they remained surgically unresectable. All seven patients received surgical treatment of the primary tumor only. In the remaining 16 patients, a simultaneous resection of the primary and metastatic tumors was performed after chemotherapy. The resection of metastatic lesions resulted in a complete remission in 15 patients and an incomplete remission in 1 patient. All five patients who never achieved tumor free status died within a few months. Of the 18 patients who achieved radiologic remission at a 30-month follow-up (range, 14-50 months), 10 (55.5%) remained continuously free of disease, 7 relapsed with new metastases, and 1 died of toxicity. In 13 of the 18 patients who underwent a complete simultaneous resection of the primary and the metastatic lesions, or whose pulmonary metastases disappeared after chemotherapy, a strong correlation was found between degree of necrosis of the primary tumor and of the metastatic tumor. CONCLUSIONS: In patients presenting with osteosarcoma of the extremity with lung metastases, the combination of aggressive chemotherapy with simultaneous resection of the primary and metastatic lesions improves traditionally negative outcomes. The strong correlation found between the histologic response of the primary and metastatic tumors supports the strategy, largely used currently in the neoadjuvant treatment of osteosarcoma, of tailoring postoperative chemotherapy on the basis of the histologic response of the primary tumor to preoperative chemotherapy.

Adolescent↗
PubMed1998

Safety and efficacy of isolated perfusion of extremities for recurrent tumor in elderly patients.

BACKGROUND: The treatment of bulky recurrent melanotic lesions of extremities with isolated limb perfusion with high dose chemotherapy offers palliation in a number of patients. However, the question is raised whether these major surgical procedures are too risky to warrant performing them in elderly patients. METHODS: Sixty-seven limbs were perfused in 60 patients with various drugs from 1976 through 1996 (35, imidazole carboxamide; 7, cisplatin; 20, carboplatin; 5, thiotepa). Among the 67 perfusions, 20 were in patients aged 70 years and older. Perfusion was performed for 16 upper extremities and 51 lower extremities by using the pump oxygenator for 1 hour. RESULTS: A total of 19 complications were noted after a total of 14 of the 67 perfusions (21%) (postoperative edema, 5; seroma, 4; wound separation or infection, 9; nonfatal pulmonary embolus, 1). The complications in 4 of 20 perfusions in the older patients (20%) were less than in 15 of 47 perfusions in the younger patients (32%). Among the 17 patients older than 70 years of age who were treated with perfusions for recurrent disease, four patients (24%) are alive with no evidence of disease (NED) for a median of 29 months (range, 16 to 80 months); one patient is now more than 6 years with NED after her third perfusion for repeated in-transit disease. Another 2 of 17 patients (12%) are alive with disease for a median of 89 months (range, 54 to 123 mos). The remaining 11 patients (64%) are dead of their disease. These data are comparable to the control rates in the group of younger patients in the study. Overall, half of all the patients (14 of 28) who died of their disease in both groups had maintained local control of their involved extremities. CONCLUSIONS: Aggressive treatment in selected patients with regional isolated perfusion of limbs for melanoma can lead to significant palliation of symptoms and salvage of limbs with adequate disease-free control and occasional survival benefit. This series of patients was associated with meaningful disease control and with few serious complications. Perfusions are tolerated well by patients in their 70s and 80s; therefore advanced age is not a contraindication to this procedure in carefully selected patients.

Adult↗
PubMed2005

Prognostic factors for survival in patients with locally recurrent extremity soft tissue sarcomas.

BACKGROUND: Factors prognostic for survival in patients with locally recurrent extremity soft tissue sarcomas (STS) are poorly defined, thus making it difficult to identify high-risk patients who may benefit from adjuvant therapy. METHODS: A total of 1421 patients underwent surgical treatment for primary extremity STS at a single institution between 1982 and 2002. Of these, 179 (13%) patients underwent complete surgical resection of an isolated local recurrence and were the subjects of this study. Clinicopathologic factors from both the primary tumor and the local recurrence were analyzed. RESULTS: The median interval to initial local recurrence was 16 months: 65% developed a local recurrence by 2 years and 90% by 4 years. Only four patients who presented with a low-grade primary tumor progressed to a high-grade local recurrence. Independent prognostic factors for disease-specific survival after local recurrence were a high histological grade (hazard ratio, 5.1; P = .0004), a large local recurrence tumor size (hazard ratio, 1.5; P = .0001), and a short local recurrence-free interval (hazard ratio, 1.6; P = .0001). Patients who developed a local recurrence >5 cm in < or =16 months (n = 44; 0 low grade) had a 4-year disease-specific survival of 18%, compared with 81% for patients who developed a local recurrence < or =5 cm in >16 months (n = 46; 11 low grade). CONCLUSIONS: Histological grade, local recurrence size, and local recurrence-free interval are independently predictive of survival in patients with locally recurrent extremity STS. A large local recurrence that develops in a short interval indicates a biologically aggressive tumor with a high tumor-specific mortality. Patients who develop such recurrences are ideal subjects for systemic neoadjuvant therapy trials.

Adolescent↗
PubMed1998

Physical examination and chronic lower-extremity ischemia: a critical review.

OBJECTIVE: To determine the clinical utility of physical examination in patients with suspected chronic ischemia of the lower extremities. DATA SOURCES: MEDLINE search (January 1966 to January 1997), personal files, and bibliographies of textbooks on physical diagnosis, surgery, and vascular surgery. STUDY SELECTION: Both authors independently graded the studies as level 1, 2, or 3, according to predetermined criteria. Criteria deemed essential for analysis of sensitivity, specificity, and likelihood ratios were (1) clear definition of study population, (2) clear definition of physical examination maneuver, and (3) use of an acceptable criterion standard test for comparison. RESULTS: The following positive findings help clinicians diagnose the presence of peripheral arterial disease: abnormal pedal pulses, a unilaterally cool extremity, a prolonged venous filling time, and a femoral bruit. Other physical signs help determine the extent and distribution of vascular disease, including an abnormal femoral pulse, lower-extremity bruits, warm knees, and the Buerger test. The capillary refill test and the findings of foot discoloration, atrophic skin, and hairless extremities are unhelpful in diagnostic decisions. Mathematical formulas, derived from 2 studies using multivariate analysis, allow clinicians to estimate the probability of peripheral arterial disease in their patients. CONCLUSION: Certain aspects of the physical examination help clinicians make accurate judgments about the presence of peripheral arterial disease and its distribution.

Aged↗