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PubMed1999

[Supramicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the extremities].

During the past eight years, we treated obstructive lymphedema of a unilateral upper extremity in 27 females and of a unilateral or bilateral lower extremity in 35 males and females with supramicrosurgical lymphaticovenular anastomoses and/or conservative treatment. The most common cause of upper limb edema was mastectomy with or without subsequent radiation therapy for breast cancer, and that of lower limb edema was hysterectomy with radiation. As an objective assessment of edema, the circumferences of the affected and opposite normal forearms or lower legs were measured 10 cm below the olecranon of the arm or the lower border of the patella. In patients who received conservative treatment (12 arms and 12 legs), the average excess circumferential length of the affected arm and leg was 6.4 and 7.1 cm over that of normal extremities, average duration of edema before treatment was 3.5 and 5.2 years, average period for conservative treatment was 10.6 months and 1.5 years, and average decreased circumferential length was 0.8 and 0.6 cm, respectively. The rate of circumferential decrease over 4 cm was none in arm and 16.7% in leg edema. In patients who underwent surgery (12 arms and 16 legs), the average excess circumferencial length was 8.9 and 9.8 cm, average duration of edema before surgery was 8.2 and 8.9 years, average follow-up after surgery was 2.2 and 3.3 years, and average decrease in excess circumference was 4.1 and 2.7 cm, respectively. The rate of circumferential decrease over 4 cm was 58.3% in arms and 50% in legs. These results indicate that supramicrolymphaticovenular anastomoses have a valuable place in the treatment of obstructive lymphedema.

Adult↗
PubMed2000

Current follow-up strategies after potentially curative resection of extremity sarcomas: results of a survey of the members of the society of surgical oncology.

BACKGROUND: The follow-up of patients after potentially curative resection of extremity sarcomas has significant clinical and fiscal implications. However, the ideal postoperative surveillance regimen for these uncommon neoplasms remains ill-defined. This study was designed to determine the current follow-up practices of a large, diverse group of physicians who care for sarcoma patients. METHODS: The 1592 members of the Society of Surgical Oncology (SSO) were surveyed regarding their follow-up practices with a detailed questionnaire mailed in 1997. Information regarding frequency of follow-up testing was requested for extremity sarcoma patients treated for cure based on 4 vignettes: low grade lesion </= 5 cm and > 5 cm and high grade lesion </= 5 cm and > 5 cm. Respondents were asked to indicate the number of office visits, laboratory tests and imaging studies performed annually during the first 5 years and the 10th year after surgery. RESULTS: Forty-five percent (716 of 1592) completed the survey. Of the 343 respondents who performed sarcoma surgery, 318 (93%) also provided long term postoperative follow-up for their patients. Ninety-four percent of respondents (295 of 318) were trained in general surgery and 5% (15 of 318) completed orthopedic residencies. Ninety-one percent (291 of 318) were also fellowship trained (80% in surgical oncology). Sixty-three percent (201 of 318) were in academic practice. Routine office visits and chest X-ray (CXR) were the most frequently performed items for each of the years. The frequency of office visits and CXR increased with tumor size and grade and decreased with postoperative year. Complete blood count and liver function tests were the most commonly ordered blood tests, but many respondents did not order any blood tests routinely. Imaging studies of the extremities were performed on the majority of patients with large (> 5 cm) low grade lesions and on both large and small high grade lesions during the first postoperative year. CONCLUSIONS: Postoperative sarcoma surveillance strategies utilized by members of the SSO rely most heavily on office visits and CXR. Tumor grade, tumor size, and postoperative year affect surveillance intensity.

Continuity of Patient Care↗
PubMed1975

Results of hyperthermic perfusion for melanoma of the extremities.

Our studies show that the malignant melanoma cell in human beings is more sensitive to the lethal effect of heat than its normal counterpart, the melanocyte. Malignant melanoma of the extremities presents unique problems; at times, local control can be extremely difficult. The addition of heat to regional perfusion with melphalan has dramatically improved the objective response of melanoma. Complications rise as the tempreature and duration of perfusion increase. These risks must be weighed carefully against the volume and extent of tumor. One hundred and eighty-five hyperthermic perfusions have been perfomed on 165 patients. When done with meticulous attention to details, this procedure is accompanied by minimal morbidity and mortality. Hyperthermic perfusion is currently the best treatment for recurrent melanoma of the extremities and has almost eliminated the necessity for amputation. Perfusion is recommended as a prophylactic measure for the more deeply invasive primary lesions. It reduces the incidence of regional recurrence. A retrospective statistical analysis of survival rates of patients treated with nonheated and heated perfusion for recurrent melanoma, State IIIA, was conducted. If the experience of the heated group continues, which from a clinical standpoint appears likely, then a striking advantage of heated perfusion over nonheated perfusion will be demonstrated. This superiority in survival rates for the heated group is now three to one or 300 per cent. The most reasonable explanation for the improvement in survival time of patients in State IIIA is stimulation of the immune response. As a result of our experience with heated perfusion of limbs, we are investigating the possibility that systemic hyperthermia may enhance the antitumor effects of various chemotherapeutic agents on melanoma.

Acute Kidney Injury↗
PubMed2001

[Arterial embolisms in the extremities].

The authors discuss the causes of development of embolism into the peripheral vessels. The most frequent site of embolism in the lower extremity is the a. femoralis communis and a. poplitea, in the upper extremity the brachial and cubital artery. Frequently a premonition of myocardial infarction is involved which was not reflected in ECG changes but was confirmed on autopsy. The most frequent source of embolization into the periphery is atrial fibrillation. The success of treatment depends on early surgical intervention (embolectomy), local thrombolysis and postoperative administration of anticoagulants. Late removal of the embolus causes local and general changes, loss of the extremity and increases the morbidity and mortality.

Aged↗
PubMed1999

[The characteristics and management of shotgun wounds of the extremities].

OBJECTIVE: To discuss the characteristics, classification and the problem of management for shotgun wounds of the extremities. METHODS: 82 shotgun wounds of the extremities, classified according to the modified rule form Sherman and Ordog's, were treated by "incision and drainage" initially, and were closed in primary, delay and later phase. The fractures were fixed by plaster, external fixator, simple internal fixator or plate fixation. Vascular injury was repaired by suture end-to-end or autograft. The injured nerves were treated in the primary or later period. RESULTS: The rate of infection was the highest in the primary closed wound, and the healing time was the longest in the later closed wound. The rate of infection was much higher in the fracture fixed by plate than the others. The results of nerve recovery in primary repair were not significantly different (except 2 case infection) from those in the later repair. CONCLUSIONS: A significant difference was noted between shotgun wound and other wound. Removal of wadding, prevention of fascial compartment syndrome, repeat planned exploration of wound, proper wound closing, external fixation of fracture, vascular debridement before anastomosis and delayed nerves repair contribute to a successful outcome in patients with extremity shotgun wounds.

Adolescent↗
PubMed2002

[Revascularized osteo-trepanation in the treatment of chronic occlusion of the lower extremities arteries].

The results of operation of revascularized osteotrepanation (ROT) in complex of treatment of 43 patients with chronic occlusion of the lower extremities arteries were analyzed. Stable clinical effect after application of ROT in patients with the ischemia II stage persisted during 40 months, III stage--25 months, "high" amputation of lower extremity in patients with IV stage ischemia was performed in 3.5-7 months. ROT is operation of choice in patients with distal form of ischemia of lower extremity, as well as while presence of contraindications for performance of reconstructive operation on main arteries.

Arterial Occlusive Diseases↗
PubMed2003

Low-molecular-weight heparin (nadroparin) and very low doses of warfarin in the prevention of upper extremity thrombosis in cancer patients with indwelling long-term central venous catheters: a pilot randomized trial.

BACKGROUND AND OBJECTIVES: Upper extremity thrombosis is a major complication of central venous catheters implanted for chemotherapy in cancer patients. Vitamin K antagonists and low-molecular-weight heparins have been recommended in this setting, but their relative benefit-to-risk ratios have never been compared. DESIGN AND METHODS: A prospective, randomized, open, parallel-group, multicenter trial was performed comparing the antithrombotic efficacy and safety of warfarin and the low-molecular-weight heparin, nadroparin, in cancer patients who had undergone central venous catheter implantation. Warfarin was given orally at a fixed daily dose of 1 mg and nadroparin was injected subcutaneously at a fixed daily dose of 2,850 IU for 90 days, or until venographically-confirmed thrombosis occurred. The primary efficacy outcome was the occurrence of upper extremity thrombosis confirmed by venography performed 90 days after insertion of the catheter, or earlier if symptoms of thrombosis had appeared. Safety end-points were bleeding and thrombocytopenia. RESULTS: Fifty-nine patients were included in the study. A total of 21 and 24 patients in the nadroparin and warfarin groups, respectively, were evaluable for primary efficacy. Six out of the 21 patients in the nadroparin group (28.6%) and 4 out of the 24 patients in the warfarin group (16.7%) had venographically-documented upper extremity thrombosis at day 90 (p=0.48). Safety was satisfactory and similar with both treatments. INTERPRETATION AND CONCLUSIONS: Warfarin at a fixed, very low dose and nadroparin at a fixed, prophylactic dose had comparable benefit-to-risk ratios in the prevention of thrombosis associated with central venous catheters in cancer patients.

Aged↗
PubMed2002

[Tumors of peripheral nerves of extremities and the brachial plexus and their surgical treatment].

BACKGROUND: The author presents the results of 32 operations in 30 patients to whom in the course of 11 years, from 1990-2001 by the microtechnique 32 tumours of peripheral nerves of the extremities and the brachial plexus were removed. PATIENTS AND METHODS: In 26 patients 28 tumours of the peripheral nerves of the extremities were removed and in 4 patients 4 tumours of the brachial plexus were removed. Three of the tumours of the brachial plexus spread intraspinally. 31 tumours of the nervous sheaths included 19 schwannomas and 12 neurofibromas. Of 12 neurofibromas six were found in four patients with Recklinghausen's disease (VRD). One patient had a tumour of non-neural elements--a lipoma. The authors did not encounter malignant tumours of nervous sheaths, benign or metastatic malignant ones which compressed or invaded the nerve or plexus. The results were evaluated according to Donner's classification of motor and sensitive functions. RESULTS: Motor functions improved but remained unaltered in 17 (89%) patients with schwannomas and in 5 (83.3%) patients with pain in the area of the affected nerve either complete or partial mitigation of symptoms occurred. In neurofibromas in 3 (50%) patients motor functions improved or remained unaltered and all patients had a partial or complete regression of painful syndromes. In 4 patients with VRD 6 tumours of the peripheral nerves of the extremities were removed, in all the motor functions improved or remained unalterted and in all a partial or complete regression of pain syndromes was recorded. The results were more favourable in smaller, more distant tumours of the nerve sheaths. CONCLUSION: Patients should be operated in departments concerned with problems of peripheral nerves.

Brachial Plexus↗
PubMed2003

[Acute thrombosis of lower extremities. Risk factors, methods of prevention and treatment].

The results of treatment of 526 patients with an acute venous thrombosis of the lower extremities aged from 23 to 70 years, including 140 (36.3%) men and 376 (63.7%) women, were analyzed. The main etiological factors of thrombosis were physical overload, operations with subsequent immobilization, trauma of lower extremities, pregnancy and delivery, tumor of small pelvis and of other localization. In 65 patients an acute venous thrombosis was complicated by thromboembolism of pulmonary artery (TEPA), 2 patients died before initiation of treatment. Conduction of conservative therapy in 314 (94.4%) patients with thrombosis of the lower extremities deep veins using fraxiparine (fraxiparine forte) have allowed to achieve considerable improvement of their state. In 80 patients with thrombosis of subcutaneous veins was performed ligature of mouth for prophylaxis of TEPA, in all of them good clinical result was noted. High efficacy of fraxiparine application in prophylactical dosage for prevention of the venous thromboembolism occurrence was noted.

Acute Disease↗
PubMed2003

[Clinical manifestations and characteristics of vascular bed involvement in atherosclerosis of lower extremities in patients with type 2 diabetes].

Clinical manifestations of arterial insufficiency and characteristics of vascular damage were compared in 68 patients (54 men, 14 women, mean age 64.5+/-1.1 years) with atherosclerosis of arteries of lower extremities including 40 patients with type 2 diabetes. Color duplex scanning was used for assessment of severity of vascular wall involvement. Ankle blood pressure was measured by Doppler technique with calculation of ankle-brachial index. Atherosclerosis of arteries of lower extremities in patients with diabetes manifested clinically as neuropathy while intermittent claudication was more characteristic of patients without diabetes. Severity of medial calcinosis and vascular wall rigidity were related to duration of diabetes. Ankle-brachial index in patients with diabetes was 20-30% and 1.5-2 times higher compared with those without diabetes with similar occlusive and nonocclusive changes of arteries of lower extremities, respectively. Color duplex scanning did not reveal differences between patients with and without diabetes in frequency of large multiple atherosclerotic plaques in abdominal aorta, iliac, popliteal arteries.

Aged↗
PubMed2003

Our experience with surgical treatment of the tumours of peripheral nerves in extremities and brachial plexus.

OUTLINE: The paper presents the results of 33 microsurgical removal of 33 tumours of brachial plexus and of peripheral nerves in extremities performed on 31 patients during the period of 11 years, from 1990 to 2001. PATIENT GROUP AND METHODS: The patient group included 26 patients treated for removal of 28 tumours of peripheral nerves in extremities and 5 patients treated for removal of 5 tumours of brachial plexus. Three of these brachial plexus tumours showed intraspinal spread. 32 tumours of neural sheath included 20 schwannomas and 12 neurofibromas. 6 of these 12 neurofibromas were observed in 4 patients suffering from Reklinghausen disease (VRD). One patient had a tumour of non-neural elements--lipoma. We did not encounter any malign tumours of neural sheaths or other neural sheath-derived tumours (benign or metastatic malign ones) that would compress or invade the nerves or plexus. The results were evaluated according to Donner classification of motor and sensory functions. RESULTS: Motor functions improved or remained unchanged in 18 (90%) patients with schwannoma. 5 patients (83.3%) with pain in the distribution of the affected nerve reported complete or partial improvement of the symptoms. Regarding neurofibroma patients, 3 exhibited either an improvement or unchanged motor functions, and all of them reported partial or complete retreat of pain symptoms. 4 patients with VRD were subjected to the removal of 6 tumours of peripheral nerves in extremities; all of them exhibited improved or stabilised motor functions and partial or complete retreat of pain symptoms. The outcome of treatments was generally better in smaller tumours of neural sheaths with more distal localisation. CONCLUSION: Patients should be treated in the early stage of tumour development when the size remains smaller and neurological deficits are absent.

Adult↗
PubMed2003

[Surgical repair of major vascular injuries in the extremities complicated by other injuries: retrospective analysis of 67 cases].

OBJECTIVE: To retrospectively analyze the surgical repair of injured major vessels in the extremities complicated by multiple other injuries. METHODS: According to different time lengths of sustaining ischemia, sites of the major vascular injuries and conditions of other injuries, 91 operations for end-to-end anastomosis, vessel grafting and repair, ligation and shunting respectively were performed on the 67 patients. RESULTS: Except for 2 fatal cases (one due to preoperative brain hernia and hemorrhagic shock, the other to thyroid crisis during operation), all other cases survived the operations. Vascular crisis occurred in 3 cases (2 arterial spasm and 1 venous crisis) 6, 7 and 12 h respectively after the operations, which were relieved by appropriate treatments and surgical explorations. One patient developed pneumonia and acute renal failure with polyuria at postoperative days 7 and 4 respectively, but full recovery was achieved. CONCLUSIONS: For patients with major vascular injuries in the extremity complicated by multiple other injuries, timely revascularization of the extremities should be performed during or immediately after emergency operations of the vital organs. Particular attention should be given to the diagnosis and repair of closed major vascular injuries in such patients, who need to be monitored for blood coagulation during operation and should receive due post-operative anti-coagulation treatment.

Adolescent↗
PubMed1992

[The correlation of the segments of the extremities as a biomechanical constant in man and mammals].

The length of human extremity segments at different stages of age development, beginning from newborns up to far-advanced age, was studied. Under examination there were 1505 humans. In addition, bone segments of the extremities were studied in 100 human skeletons and 225 skeletons of mammals from 8 orders. On the basis of a functional analysis of the length of bone segments and the detected high correlative dependence two homogeneous (homodynamic) pairs in extremities of the man and animals were identified mainly performing the supporting, static and repulsive functions. An equality between the length of these pairs was established called the biomechanical constant. The biomechanical constant regulates the proportionality of bone links as a mechanical lever in the process of age development of man as well as in the process of evolution of mammals in changing the types of locomotion from foot-walking up to phalanx-walking.

Aging↗
PubMed1992

The changing role of amputation for soft tissue sarcoma of the extremity in adults.

The role of amputation in soft tissue sarcoma of the extremity has decreased at Memorial Sloan-Kettering Cancer Center during the last 20 years. In an attempt to determine the reasons for this change in therapy, an analysis of two separate databases involving 1,057 patients compiled during the periods of 1968 to 1978 and 1982 to 1990 was performed. The patients requiring amputation for soft tissue sarcoma of the extremity in the two databases (n = 233) were compared in an attempt to determine any significant differences between the two time periods. The groups were specifically compared for differences in risk factors, indications for amputations and the effect a decreasing incidence of amputation in the 1982 to 1990 group had on local recurrence and overall survival between the two groups. Despite similarity of risk factors and indications for amputation, the decreased incidence of amputation during the 1982 to 1990 period was associated with a significant decrease in local recurrence after amputation and no significant change in overall survival compared with the 1968 to 1978 group. Absence of local recurrence was associated with significant improvement in survival. Possible reasons for the shift in therapy, as well as the present and future role of amputation in soft tissue sarcoma of the extremity, are discussed.

Adolescent↗
PubMedDate not supplied

[Palliative surgical treatment of spastic paralysis in the upper extremity].

AIMS: In this paper we review the main studies conducted on therapy applied to the bony and soft parts in spastic paralysis of the upper extremity. DEVELOPMENT: Spasticity presents muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motoneuron syndrome. Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, paediatricians, orthopaedic surgeons and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, and the deformity of the fingers (swan-neck and thumbs-in-palm). The primary objectives in these patients will be to improve communication with their surroundings, perform activities of daily living, increase mobility and walking. CONCLUSIONS: The surgical treatment applied by orthopaedic surgeons in the upper extremities are aimed at achieving an enhanced adaptive functionality rather than morphological normality. Factors to be taken into account include age, voluntary control over muscles and joints, level of severity of the spasticity (Ashworth scale) and stereognostic sensitivity. In general, on soft parts we will use procedures such as dehiscence or lengthening of the flexor muscles of the shoulder and elbow or of the adductor of the thumb; transfer of the pronators in order to adopt the supinating function or of the flexors so as to reinforce the extensors of the forearm, and capsulodesis or tenodesis in the hand. The bony procedures will consist in derotational osteotomies of the humerus and radius and arthrodesis in the wrist or in the metacarpophalangeal joints of the thumb, depending on whether there is greater rigidity or age in the former cases or instability in the latter.

Humans↗
PubMed2003

[Comparative assessment of different methods of treatment of chronic critical ischemia of lower extremities in elderly and senile patients].

Results of using different methods of treatment of chronic critical ischemia of lower extremities were analyzed in 267 elderly and senile patients. Ischemia of the lower extremities of the III degree was noted in 83% of the patients, the IV degree ischemia--in 17%. In 86 patients who underwent primary high amputation of the lower extremity 2 years survival was noted in 33.7%. In 89 patients treated conservatively during 12-14 days good and satisfactory results were obtained in 58.4%, amputations were made in 41.6%. The 2 years survival was 66.3%. In 92 patients primary reconstructive operations resulted in good and satisfactory outcomes in 75 (81.5%) out of them with the 2 years survival in 88.0%.

Aged↗
PubMed2004

Role of surgery in local treatment of Ewing's sarcoma of the extremities in patients undergoing adjuvant and neoadjuvant chemotherapy.

Although more and more patients with Ewing's sarcoma of bone (ESB) are being treated by surgery, the relative role of surgery and radiotherapy in the local treatment of this tumor has yet to be determined. Because the outcome of ESB may differ according to the anatomical site of the tumor, results reported in the literature, which generally refer to series with tumors located in all sites, may be selection biased. Therefore, we have retrospectively evaluated patients with ESB exclusively in the extremity and locally treated by surgery or radiotherapy. Two hundred and sixty-eight patients treated at Rizzoli 1979-1996 for non-metastatic ES of the extremities were assessed. Chemotherapy was administered according to four sequentially activated protocols. One hundred and thirty-six patients were treated by surgery, 70 by surgery and radiotherapy, and 60 patients by radiotherapy. Two patients underwent only chemotherapy. The follow-up range was 5-23 years (mean 13 years). One hundred and fifty-two patients remained continuously free of disease, 108 relapsed, 2 died of chemotherapy toxicity and 6 developed a second malignancy. The 5-year event-free survival (EFS) and overall survival (OS) were respectively 62 and 69%. Although patients of all groups were matched for possible risk factors, the rates of 5-year EFS and local control were significantly lower in patients treated with radiotherapy compared to patients treated by surgery or surgery and radiotherapy (48% vs 66%, p=0.002; 80% vs 94%, p=0.0001). Furthermore, in group 3 there were 6 secondary malignancies. Our results indicate that surgery should always be considered in the local treatment of ES of the extremities. Postoperative radiation therapy must be added in case of inadequate surgical margins.

Adolescent↗
PubMed2003

[Progress in the study on synergetic control principle of human upper extremity and related issues].

Human upper extremity is the most complex and flexible executor during the human movement, coordination analysis of the synergetic control principle of human upper extremity is of great significance in trajectory planning and real-time control of anthropopathy robots and intelligent prosthesis system. Most studies have only been performed within the last 10 years. This paper surveys the research in the structure characteristic and redundancy coordination principle of human upper extremity, and the developments of various prospects of anthropopathy robots, intelligent prosthesis, gymnastic science and rehabilitation evaluation are discussed.

Humans↗