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At least 1,207 records · Page 67Linked to original sources
PubMed1987

Primary malignant bone tumors of the shoulder girdle: surgical technique of resection and reconstruction.

Limb ablation for tumors of the shoulder is a devastating procedure. Recent advances in preoperative investigative measures, adjuvant chemotherapy, and reconstructive techniques have resulted in an increased interest in limb-sparing resection. For limb-sparing procedures to present a viable alternative in these cases, recurrence rates must be comparable to those obtained with ablative surgery. In addition, the resection must result in an improvement over the status obtainable with prosthetic devices. Twenty-four patients underwent limb-salvage procedures of various forms for primary bone tumors of the shoulder girdle. At follow-up (average: 33 months), 19 patients were alive without disease, one was alive with disease, and four were dead. One patient had local recurrence. All surviving patients enjoyed nearly normal function of the distal extremity. Improvements in techniques of soft tissue reconstruction in an effort to gain function and stability after wide resection of these tumors are necessary. Results indicate that these limb-salvage attempts offer successful alternatives to mutilating and crippling proximal amputations of the upper extremity.

Adolescent↗
PubMed1986

Reconstruction following head and neck burns.

Burn reconstruction of the head and neck must first start with special care to this anatomic area in the early acute phase, with appropriate early débridement and coverage with sheet grafts of medium thickness into unit facial orientation. Postoperative garment and mask splinting, will help lessen the hypertrophic scar formation that frequently follows facial burns and skin coverage. Carefully planned reconstruction of these areas is indicated, with priority given first to the neck, then to the periorbital area, and then to perioral areas. Principles of scalp, ear, nasal, and cheek reconstruction following burns of the face are carefully outlined. The unit concept of burn scar resurfacing of the face has been the mainstay of our treatment. We have emphasized skin coverage of the face from similar donor site areas. The emotional and psychological effects of facial scarring secondary to severe burns are crippling to patients. Although numerous reconstructive surgical procedures may lessen the deformity, ultimately burn patients realize that their burn scars are permanent and no surgeon can give them back their original facial appearance. These patients need strong and continued support and reassurance from their physicians and nursing professional staff to maintain their self-identity and confidence.

Adolescent↗
PubMed1986

A scientific basis for surgery in rheumatoid arthritis.

Understanding a disease process provides the scientific basis for specific treatment. In rheumatoid arthritis (RA), disease(s) of unknown cause, the lack of knowledge about the intrinsic involvement of the articular collagenous tissues (ACT) as a site for the deposition and persistence of immune complexes may have led to poor long-term results of surgery, especially synovectomy. Because we may now presume that immune complexes in ACT provide inflammatory, immune foci for chronic synovitis, ablative surgery of the damaged cartilaginous tissues is a specific remedy. Such knowledge may be used judiciously with techniques of fusion, resection, and arthroplasty to improve and maintain the long-term function of patients with the crippling seropositive form of the disease.

Arthritis, Rheumatoid↗
PubMed1987

The kinetics of immune reconstitution after human marrow transplantation.

Human marrow transplantation for the treatment of malignant and nonmalignant disorders is becoming an established modality of therapy. As in any aggressive therapeutic modality, the benefits must be balanced with the risks of the therapy. The aggressive chemoradiotherapy used to prepare patients for marrow transplantation creates a transient immunodeficiency disorder postgrafting until the transferred donor marrow reestablishes a competent immune system. Immune reconstitution posttransplant follows a general pattern developing from immature to mature immune functions. Immune reactivity during the first month postgrafting is extremely low. Cytotoxic and phagocytic functions recover by day 100, while more specialized and cooperative functions of T and B cells remain impaired up to one year or more postgrafting. After the first year postgrafting, the various components of the immune systems of most healthy marrow recipients begin to work synchronously, whereas the immune systems of recipients with chronic graft-v-host disease (GVHD) remain crippled. Recent evidence shows that transfer of specific immunity from marrow donors to marrow recipients plays a role in reestablishing immunocompetence. Transferred antigen-specific immunity may explain why more recipients do not die from overwhelming infections.

Bone Marrow Transplantation↗
PubMed1987

Grief in the grounded aviator.

Grounding aviators is an important and difficult aspect of being a flight surgeon. The psychological impact that grounding has on a flier may not only represent a serious pathological process in itself, but may also detrimentally affect the flight surgeon's relationships with other crewmembers. Grounding represents a loss to the aviator, the severity of which varies with pre-morbid motivation to fly. As a loss, grounding elicits grief; this must be dealt with effectively by the patient, with the help of the flight surgeon, or an unresolved grief reaction may cripple the ex-flier and hinder the flight surgeon's effectiveness.

Aerospace Medicine↗
PubMed1987

Coping with rheumatoid arthritis.

Rheumatoid arthritis, a chronic systemic connective tissue disorder that affects women three times more often than men, that is of unknown cause, and that involves inflammatory changes primarily in the small peripheral joints of the hands and feet, afflicts approximately 8 million people in the United States. In its mildest form, rheumatoid arthritis causes little interference with normal activity. However, in its severest form, it can render the afflicted person bound to a wheelchair, house, or even a bed. As a result of its crippling effects, simply accomplishing the tasks of daily living can be a feat for some people. Coping with the existence of pain, disabling effects, and/or deformities brought on by rheumatoid arthritis is not an easy task for the afflicted person. To cope with the physical aspects of the disease, the afflicted person is likely to use the coping mechanisms of information seeking, direct action, inhibition of action, intrapsychic processes, and social support. Which coping mechanisms are used, how the mechanisms are used, and how effective the mechanisms are, must be determined by the nurse so that appropriate psychosocial interventions can be planned and implemented.

Adaptation, Psychological↗
PubMed1976

Chemical injuries of the upper extremity.

The prompt recognition and management (Tables 8-1 and 8-2) of chemical burns of the upper extremity may prevent injury to the deep structures of the hand and may make the difference between satisfactory rehabilitation and crippling deformities. Immediate irrigation with water is the single most important treatment that can be carried out, and should be continued for at least an hour and often for several hours, depending on the severity of the injury. Precious time should not be wasted hunting for a specific neutralizing agent. Hydrofluoric acid injuries and phosphorus injuries are the two exceptions to this principle. After copious irrigation and débridement, small superficial burns may be treated without dressings or topical therapy. Large partial-thickness burns are best treated with Sulfamylon burn cream and then with with biologic dressings until healing is achieved. Full-thickness injuries of limited extent should be excised and skin-grafted to regain maximum function, and more extensive burns treated in a nonexicisional regimen.

Acids↗
PubMed1978

Reiter's disease.

Reiter's disease can no longer be considered a rare and relatively benign syndrome consisting of the clinical triad of urethritis, conjunctivitis and arthritis. It is, in fact, a post-infectious reactive arthritis that belongs to a new group of diseases now called seronegative spondyloarthropathies. These diseases are characterized by an extremely high association with the genetic marker, human leukocyte antigen B27. In its full course, the disease often is incomplete with its initial clinical manifestations and characterized by chronicity and progressive crippling recurrences.

Adolescent↗
PubMed1986

Informed consent and the elderly patient.

Achieving a moral informed consent from a patient is certainly no easy task for the physician. Patient autonomy has become a watchword of the medical profession and has promoted to some extent an emphasis on the idea of noninterference with the patient as the essential feature of the physician's respect for this autonomy. This is unfortunate because noninterference in many instances really does not take into account the transforming effects of illness and their impact on informed consent. In illness, the body is interposed between us and reality, and it impedes our choices and actions and is no longer fully responsive. Illness forces a reappraisal and in doing so opens up old anxieties and imposes new ones, often including the real threat of death or drastic alterations in lifestyles, such as becoming ventilator-dependent. Fear alone may cripple the ability of the patient to choose. In any consideration of informed consent, the extent of the patient's illness and suffering must always be considered. Adequate interaction with the elderly patient that is necessary for an informed consent consists of a combination of "objectivity" and "cooperation." Cooperation is shown by psychologically reproducing in the mind of the doctor, insofar as possible, the meaning the patient's illness has for him. Without such knowledge, the physician cannot assist a patient in restoring some control over his life, or in understanding his values, both of which are so essential in the decision-making process. The meaning of informed consent is vacuous at best without this objectivity and cooperation. Along with this interaction, the elderly patient must be placed in such a position that throughout his illness he maintains a free choice to decide while he is mentally able to do so. Simply knowing that this freedom exists removes many of the doubts and fears constraining the patient's own sense of autonomy. As a final statement regarding informed consent, we should note that any success by the physician in dealing with problems surrounding the patient's informed consent is always central to the strength of the physician's relationship with the patient. Because of the changing features of this relationship today, the physician should always be ready to implement the steps necessary to maintain the integrity of that relationship. The covenant of faithfulness demands nothing less.

Aged↗
PubMed1979

Musculocutaneous flaps in reconstructive pelvic surgery.

Gracilis musculocutaneous flaps are useful in reconstruction of many crippling pelvic defects. They are especially beneficial for vaginal reconstruction at the time of pelvic exenteration. Twenty patients having vaginal reconstruction with musculocutaneous flaps are presented. Nineteen (95%) have vaginas adequate for sexual function.

Adult↗
PubMed1986

[Reconstruction prosthesis of the upper part of the femur. Intermediate results in 20 resections for tumor. Current trends].

Twenty total hip prostheses inserted after massive resection of the upper part of the femur for tumour have been reviewed after a 3 year mean follow-up. Fifteen cases were of primary malignant tumour. The mean resection of the femur measured 175 mm in length and was reconstructed using Cochin prostheses. From the oncological standpoint, the results were comparable with those obtained after disarticulation of the hip, but the functional results were, of course, much better. Five patients were able to resume their previous professional work; 13 were able to have a normal type of life and only 2 were severely crippled. Nineteen hips were painless. Nine patients could walk without a stick, 9 used one stick for walking outside and 2 used sticks permanently. Two cases were complicated by dislocation. Despite an extensive resection of the greater trochanter, one third of the hips were stable on standing on one leg, thanks to the design of the prostheses. No prostheses broke. Two loosenings of the acetabular cup had to be revised. No loosening of the femoral stem was found, despite the frequency of osteolysis of the diaphysis to 4-5 cms below the level of resection. The authors intend now to improve the design of the prostheses and to aid the reinsertion of the muscles, which can be improved by using homografts surrounding the femoral prostheses.

Femoral Neoplasms↗
PubMed1987

Long-term results of ventricular assist pumping in postcardiotomy cardiogenic shock.

Short-term survival of patients who require ventricular assist pumping for postcardiotomy cardiogenic shock has been encouraging and has provided enough survivors to allow evaluation of long-term results. We observed nine survivors, 39 to 69 years of age (mean = 54.6) for 10 to 53 months (mean = 31) after their discharge from the hospital. In three patients, the angiographic ejection fraction was normal before the operation, whereas in six patients it was moderately to severely impaired. All nine patients were in New York Heart Association Functional Class IV before operation. After operation, eight of the nine patients were in Functional Class I or II. In the remaining patient, the ejection fraction fell markedly and the postoperative functional class remained unchanged. Two patients were employed full-time and one, part-time. Five patients were retired but active and had no cardiac disability, although two of the five did have residual partial noncardiac disability. The remaining patient, a housewife, continued to have compensated congestive heart failure but was relieved of angina. During the follow-up period, five of the nine patients died suddenly after 12, 18, 25, 30, and 38 months from causes that included pulmonary embolus and probable arrhythmias. Survivors who have had ventricular assist pumping for postcardiotomy cardiogenic shock have a good chance of resuming active lives. The risk of being a "cardiac cripple" is small, as is the risk of significant noncardiac disability.

Adult↗
PubMed1986

[Earth currents as a cause of fry losses in a trout stock].

The grounding of the mains by the energy suppliers causes sporadic alternating earth currents. From water over the housings of areator and its earth-connected guardwire such currents may occur. In a South German trout hatchery these earth currents led to losses of 30% among the influenced fry and to a 25% crippling among the surviving fry. Cause, clinical events and possible preventive measures are discussed.

Animals↗
PubMed1985

Care of the young hemophiliac. New socioeconomic demands and the changing patient-physician relationship.

Over the past two decades, greater knowledge about hemophilia and vastly improved treatment have led to a veritable revolution in the care of this crippling disease. In prospect is an era in which both short- and long-term sequelae may be avoided altogether. Much of the progress has been effected through novel methods of care delivery in which the relationship of the physician and his patient begins to resemble more a partnership between equals than the traditional dependency of the chronically handicapped on his doctor. Yet with, and because of, these changes ethical and legal aspects are inevitably introduced, some of which are discussed in the article. These deal with issues of public policy, distributive justice, avoidance of harm, risk imposition and risk-taking, confidentiality, and paternalism. When applicable, the discussion surrounds a prototypical case which illustrates the real dilemmas which treaters and patients may have experienced or may encounter. Following each issue is a discussion intended to show how the ethical and legal dimensions may be analyzed in a way which allows certain justifiable decisions. These analyses are themselves based upon ethical premises which are commonly accepted, legal precedent, or both. While some of these considerations are relevant to the older hemophiliac as well, most deal with topics affecting those most likely to benefit from the advances and to contend with the challenges of this new era of hemophilia care: the young hemophiliac and his physician.

Adolescent↗
PubMed1985

Surgical treatment of juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis is rare and only affects a small number of children but can lead to severe crippling of adolescents or adults unless they are treated early. In this review the problems encountered in the surgical treatment, particularly those caused by skeletal stunting are discussed. The results of synovectomy of the knee and elbow are valuable procedures in suitably selected patients. Stapling of the knee in young children with genu valgum gave good correction in the majority. Soft tissue operation on the hip and knee in young children with severe deformities have given encouraging results. Complications and the results of reconstructive surgery for the hip and knee are discussed, and it was found that total joint replacement in these young patients with badly damaged hips is fully justified before they become chairbound.

Adolescent↗
PubMed1985

Intracranial hemorrhage in utero due to isoimmune neonatal thrombocytopenia.

A case is presented of isoimmune neonatal thrombocytopenia complicated by spontaneous intracranial hemorrhage in utero. Maternal platelets were found to be negative for the PLA1, Baka, and HLA-A2 antigens. The present case demonstrates that the classical conservative approach of elective cesarean section can not guarantee against this crippling event.

Adult↗
PubMed1985

Long-term follow-up of postcardiotomy patients with profound cardiogenic shock treated with ventricular assist devices.

Success of ventricular assist devices in patients with postcardiotomy shock has provided enough survivors to allow evaluation of the length and quality of life. Fifteen survivors from 28 to 68 years (mean 53) old from four centers were followed for 6 to 77 months (mean 35) after discharge from the hospital. Four patients suffered perioperative myocardial infarctions. In three patients, ventricular function was normal before surgery and remained so afterward. Of 12 patients with moderate or severely impaired ventricular function, five improved, five were unchanged, and two were worse. One patient died 6 months after surgery of cardiomyopathy. Seven patients are employed full-time and one works part-time. Five patients are retired but active and one is moderately disabled. NYHA functional class improved in the patients as a group: 13 were in classes III and IV before surgery and 13 were in classes I and II after surgery. Two patients had noncardiac partial disability. Survivors of ventricular assist device support for postcardiotomy shock have an excellent chance for high-quality life and the risk of crippling cardiac disability is small.

Adult↗
PubMed1985

The effects of child abuse as seen in adults: George Orwell.

The author presents the case of a patient who showed the massive defensive effects seen in people who were abused in childhood. These effects are similar to those described in George Orwell's 1984 and in his autobiographical writings: denial and "doublethink"; masochistic submission to the tormentor; turning of anger against the self and loving "Big Brother"; identifying with the abuser and tormenting others; a burgeoning of anal mechanisms and obsessive phenomena that results in a massive isolation of affects; excessive emotional control alongside outbursts of rage. The interference with memory and emotions compromises identity and humanity. The unforseeable evolution of innate gifts in a child sometimes permits a partial transcendence of these crippling defenses, as Orwell partially transcended what appears to have been the emotional deprivation of his childhood and what he felt to have been the abuse of his schoolboy years.

Child↗