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PubMed1990

[Vascular care in devastating injuries of the extremities].

The authors present an account on the treatment of blood vessels in 15 patients with serious devastating injuries of the extremities in 1982-1989. In 10 patients the injury was on the upper and in 5 on the lower extremity. In the majority of patients for reconstruction of arteries and veins venous grafts were used. In 8 patients, i.e. in 53.3%, the result was good, in 2, i.e. 13.3%, it was satisfactory and in 5, i.e. 33.3% patients, a secondary amputation had to be performed. The authors describe the surgical procedure and emphasize the necessity of team work of the vascular surgeon, traumatic surgeon and possibly plastic surgeon in the treatment of devastating injuries of the extremities. The authors draw attention to the importance of compartment and reperfusion syndrome which may complicate these injuries, as well as to the role of free oxygen radicals and the necessity to influence their noxious effect during treatment of these injuries during the per- and postoperative period.

Adolescent↗

PubMed1990

[Characteristics of the sequelae to frostbite of the extremities].

At the burn centre in Donetsk, from 1979 to 1988, 236 sufferers with a III-IV degree frostbite of the extremities were treated. Operated on were 189 patients, who underwent necrectomy, amputation of the extremity and different types of skin plasty. Of these patients, 49.8% were recognized as invalids. After 1-10 years, all the patients after a III-IV degree frostbite of the extremities make complaints, require different types of treatment, 38.9%--the operative one. For timely and qualitative rehabilitation of this category of the sufferers, their prophylactic medical examination is necessary.

Extremities↗

PubMed1989

[Isolation perfusion chemotherapy using cisplatin in malignant tumors of the extremities].

Since 1960 isolation perfusion chemotherapy has been performed as a preoperative procedure combined with surgery in 226 patients with malignant tumor of the extremities in our department. In this report we presented the result of isolation perfusion chemotherapy using cisplatin (CDDP) for 27 patients since 1983. The histologic classification of the malignant tumor was osteosarcoma in 17 patients, malignant fibrous histiocytoma (MFH) of bone in 8, and other tumor in 2. The extremity was perfused with CDDP (100 micrograms/ml) for 60 minutes. Of 27 patients, 11 were treated with hyperthermic isolation perfusion. The two-year survival rate of the 15 patients with osteosarcoma was 80%, and that of the 7 patients with MFH of bone 71%. The tumor was microscopically analyzed, and the ratio of necrotic to viable tumor cells was calculated. The degree of tumor necrosis was classified as excellent (greater than or equal to 95%), good (80-94%), fair (50-79%), and poor (less than 50%). Of 16 patients, 7 were excellent, 5 good, 3 fair and 1 poor. We concluded that isolation perfusion chemotherapy using CDDP is an effective procedure combined with surgery for malignant tumor of the extremities.

Adolescent↗

PubMed1987

[Diagnosis and treatment of metastatic bone cancer of the extremities].

Eight hundred and thirty-six patients with metastatic cancer in the bone excluding autopsy findings, occurring between January, 1976 and December, 1985 were reviewed. The most frequent site of primary focus was the breast (33.2%), followed by lung (24.6%). Three hundred and forty-two patients (40.9%) were male and 494 (59.1%) female. Diagnosis of bone metastasis was based on abnormal accumulation in the bone scintigram and abnormal findings in the bone X-ray at the same site. Out of 836 patients, 285 had metastatic skeletal lesion including extremities and 43 had a solitary lesion of the extremity. The most frequent site of bone metastases in the extremity was proximal femur and involvement of the femur was 65.2% and that of humerus was 25.6%. The majority of the patients were treated by irradiation (24.9%), irradiation with chemotherapy and/or hormone therapy (21.1%), chemotherapy (18.6%) and chemotherapy with hormone therapy (17.2%), on the other hand, only 25(8.8%) of 285 patients were treated by surgical procedures. Cumulative survival rate after diagnosis of bone metastasis varied with site of primary focus and 5 year survival rate of all cases was 6.1%. Clinical courses after skeletal metastasis were separated into two types, and one type was breast type which was slow and other type was lung type which was rapid. The most important factor for the prognosis of the patients with bone metastasis is thought to be the primary site of origin.

Adult↗

PubMed1976

[Preservation of crushed extremities].

For the conservation of crushed extremities all achievements of up-to-date traumatology are to be used. The impairement of the seriously crushed extremity displays a certain similarity to the polytraumatism involving the whole organism. This is to be taken into consideration in the surgical treatment. Conserving the vitality of the extremity deferred treatment and reconstructive operations at a later date become possible. As absolute rule must be in view that all cases are to be examined with the greatest care and individually, as regards the surgical treatment.

Adolescent↗

PubMedDate not supplied

[Late surgery on injured nerves of the extremities].

The work characterizes 424 patients with injuries to the nerves of the upper and lower extremities who were operated on one year after the trauma and later. It was established that such factors as the type of injury, the length of the defect in the nerve, and the degree of "refreshment" of the nerve segments may be important in predicting the outcome of the late suture applied to the nerves of the extremities. The severity of the injury and faults in the diagnosis and treatment are the main causes of the prolonged delay in nerve repair. Some peculiarities of a late suture applied to the nerves of the extremities are pointed out.

Adolescent↗

PubMed1986

Soft tissue sarcomas of the distal extremities.

Multimodality therapy and limb salvage procedures constitute a significant advance in the treatment of soft tissue sarcoma of the extremity. The applicability of these procedures to soft tissue sarcoma of the distal extremities was evaluated in a retrospective study of 159 such cases treated during a 10-year period. Thirty-seven patients were treated by operation alone, 57 had operation and adjuvant chemotherapy, and 65 had multimodal therapy. The distal extremities are unusual sites for soft tissue sarcomas and accounted for only 20% of our patients with sarcoma. The majority of patients were younger than 50 years and the sex distribution was approximately equal. The major histologic types were synovial cell sarcoma (18.2%), fibrosarcoma (15%), liposarcoma (13.8%), and rhabdomyosarcoma (13.8%). The 5-year survival rate was 72% with multimodality therapy, 72% for operation and chemotherapy, and 51% for operation alone. The local recurrence rate was 13% with operation alone, 9% with operation and adjuvant chemotherapy, and 12% with multimodality therapy. Based on our review, wide local excision and adjuvant chemotherapy proved to be as effective as multimodal therapy.

Adult↗

PubMed1984

[Metabolic disorders and functional properties of erythrocytes in acute arterial obstruction of the extremities].

On the basis of experimental studies (in 43 rabbits) of the model of acute arterial obstruction and examination of 19 patients with various kinds of acute ischemia of the extremity it was established that the development of the ischemic lesions of the extremity can result in significant changes in the metabolism of adenyl nucleotides and deformability of erythrocytes. The value of the erythrocytes deformability gradient can show the degree of reversibility of ischemia of the diseased extremity.

Acute Disease↗

PubMed1983

Lower extremity manifestations of phenylketonuria.

Phenylketonuria is an inborn error of metabolism with its most notable characteristic being that of mental retardation. The literature describing this disorder has been reviewed to identify the abnormal lower extremity findings in affected individuals. The dermatologic, osteologic, and neuromuscular systems were all found to be involved. Lower extremity physical examinations were then performed on nine phenylketonuric adults. It was determined that several of the reported manifestations of phenylketonuria were similarly evident in these individuals as well as the presence of additional lower extremity pathology not previously documented. However, the conclusion was made that all findings, past and present, were variable and that no consistent manifestation was apparent.

Adult↗

PubMed1995

Prognostic value of preoperative C-reactive protein concentration and white cell count in acute extremity ischaemia.

OBJECTIVE: To find out if the C-reactive protein (CRP) concentration and the white cell count (WCC) are of any prognostic value in patients with acute extremity ischaemia. DESIGN: Retrospective study. SETTING: Tampere University Hospital and Jyväskylä Central Hospital, Finland. SUBJECTS: 129 patients with acute extremity ischaemia. MAIN OUTCOME MEASURES: Preoperative CRP concentration, white cell count, packed cell volume, serum creatinine concentration, major amputation and death. RESULTS: The median (range) CRP concentration was 50.0 (3-271) mg/l in the 28 patients who underwent major amputation or died (group 1) and 11.0 (1.175) mg/l in the 65 patients who survived with viable limbs (group 2) (p = 0.007). The median (range) WCC was 13.1 (5.9-42.0) x 10(9)/l in group 1 (30 patients) and 9.5 (2.2-23.9) x 10(9)/l in group 2 (79 patients) (p < 0.001). The cut-off point of 20 mg/l for CRP and 11.0 x 10(9)/l for WCC had negative predictive values of 0.83 and 0.85 for amputation and mortality, respectively. CONCLUSION: Preoperative CRP concentration and WCC correlated with limb salvage and mortality in patients with acute extremity ischaemia.

Acute Disease↗

PubMed1998

Locally recurrent soft tissue sarcoma of the extremities.

BACKGROUND: The management of locally recurrent extremity soft tissue sarcoma remains challenging. This study was undertaken to evaluate the long-term outcome after therapy for isolated locally recurrent soft tissue sarcoma (STS) of the extremity. METHODS: Between January 1, 1980, and December 31, 1990, 52 patients were treated at The University of Texas M. D. Anderson Cancer Center for locally recurrent extremity STS. The records of the subset of these patients (n = 36) with isolated local recurrence were examined to document clinicopathologic and treatment factors and to evaluate outcome using the end points of local recurrence-free, recurrence-free, and overall survival. RESULTS: Limb-sparing conservative surgery was possible in 24 patients (75%). Twelve (33%) of 36 patients were treated by surgery alone, 23 patients (64%) were treated with combined modality therapy (surgery plus radiation and/or chemotherapy), and 1 patient had radiotherapy only. Sixteen (44%) of 36 patients had no further recurrence of any type at a median follow-up of 58 months (range, 4 to 173 months). The 5-year actuarial local recurrence-free, recurrence-free, and overall survival rates were 72%, 45%, and 77%, respectively. CONCLUSIONS: Limb-sparing conservative surgery is possible in the majority of patients with isolated locally recurrent STS. Durable local control can be established with individualized local treatment strategies. These results support aggressive multimodality limb-sparing treatment approaches for these patients.

Adolescent↗

PubMed1999

The natural history of extremity venous repair performed for trauma.

Surgical repair of extremity venous injuries remains controversial. Literature supports both ligation and repair when analyzed for functional recovery. However, few studies review the natural history of venous repair for trauma. Twenty patients were prospectively enrolled in a protocol of immediate repair of major extremity veins. Simple venorraphy and complex reconstructions were performed at the discretion of the operative team. Patients were studied by contrast venogram on postoperative day 3 and 6 weeks after surgery. Patients with occluded repairs at 3 days received a 5-day course of intravenous anticoagulation and were discharged. Overall, patency at 3 days was 55 per cent and increased to 88 per cent at 6 weeks (P < 0.02). Lateral venorraphy and direct reapproximation had higher patency rates than complex repairs at 6 weeks (92% versus 50%; P < 0.05). All veins that were patent at 3 days remained patent (correlation coefficient 1.0). Repair of traumatized extremity veins carries minimal morbidity and has a high rate of early and eventual patency. Long-term anticoagulation in the face of early thrombosis is unnecessary.

Adolescent↗

PubMed2002

Sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis: a systematic review.

OBJECTIVES: To determine the sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis and to determine the safety of withholding anticoagulant therapy in patients with negative ultrasonographic results. DATA SOURCES: The MEDLINE database was searched for literature published from January 1, 1980, to December 31, 2000, that evaluated ultrasonography for the diagnosis of upper extremity deep vein thrombosis. Bibliographies of the retrieved articles were cross-checked to identify additional studies. STUDY SELECTION: All prospective English-language studies were selected. Retrospective studies, review articles, and case reports were excluded. DATA EXTRACTION: Two of us (B.O.M. and S.W.R.) used predefined criteria to independently assess each study. Data on sensitivity and specificity and the associated 95% confidence intervals were recorded when available. DATA SYNTHESIS: Only one study met all of the predefined criteria for adequately evaluating sensitivity and specificity. The sensitivity of duplex ultrasonography ranged from 56% to 100%, and the specificity ranged from 94% to 100%. No study evaluated the safety of withholding anticoagulant therapy without additional testing in patients with negative ultrasonographic results. CONCLUSION: The safety of withholding anticoagulant treatment in a patient with suspected upper extremity deep vein thrombosis and negative ultrasonographic results is uncertain.

Anticoagulants↗

PubMed1977

Cervical spondylotic myelopathy with reversible fasciculations in the lower extremities.

Cervical spondylosis and motor system disease can appear in a similar manner with upper and lower motor neuron signs. Four patients with spasticity and fasciculations in the upper and lower extremities had surgical decompression for cervical spondylosis. Postoperative examinations at 24 to 48 months, including electromyographic studies, disclosed neurological improvement in all patients and loss of fasciculations in the lower extremities in three. Three mechanisms by which cervical spondylosis might cause fasciculations in the lower extremities are vascular insufficiency, cord traction, and denervation.

Adult↗

PubMed1998

A quantitative review of mortality and developmental disability in extremely premature newborns.

OBJECTIVES: To summarize the literature on mortality rates and prevalences of major neurodevelopmental disabilities and to examine trends of these outcomes over time in extremely premature neonates. DATA SOURCES: MEDLINE was used to search the English literature for studies published since 1970 reporting on both mortality and disability in infants born at or before 26 weeks' gestation (extremely immature [EI] cohort), with a birth weight of 800 g or less (extremely small [ES] cohort), or subgroups of these. STUDY SELECTION: Studies were included in the analysis if all of the following were reported: mortality; direct examination of 75% or more of the survivors; and the proportion of patients with at least 1 of the following disabilities: cerebral palsy, mental retardation, blindness, and deafness. Studies reporting cohorts included as a subset of cohorts in another study were excluded. Forty-two studies providing mortality and disability data for 20 cohorts of 4116 EI infants and 38 cohorts of 4345 ES infants born after 1972 met the inclusion criteria. DATA EXTRACTION: Data were abstracted from all studies that met these criteria by two of us (J.M.L. and D.E.W.), independently; the data were then cross-checked to ensure accuracy. RESULTS: Survival averaged 41% for EI infants and 30% for ES infants, and it increased significantly with time. In contrast to mortality, the prevalences of major neurodevelopmental disabilities among survivors have not changed over time. The most common major disability was mental retardation, found in 14% of EI and ES survivors. Cerebral palsy was found in 12% of EI survivors and 8% of ES survivors, blindness was found in 8% of EI and ES survivors, and deafness was found in 3% of EI and ES survivors. Overall, 22% of EI survivors and 24% of ES survivors were classified as having at least 1 major disability. Each 100 EI or ES livebirths yielded 7 children with major disabilities; this prevalence was correlated with survival across cohorts. CONCLUSIONS: The prevalence of disabilities had not changed among EI or ES survivors with increasing survival. However, increasing survival of these infants has resulted in a steadily increasing prevalence of children with disabilities.

Birth Weight↗

PubMed2000

Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization.

OBJECTIVE: To investigate biological and health services predictors of extreme neonatal hyperbilirubinemia in a health maintenance organization. DESIGN: Nested case-control study. SETTING: Eleven Northern California Kaiser Permanente hospitals. SUBJECTS: The cohort consisted of 51,387 newborns born at 36 weeks or later weighing 2000 g or more. Cases were newborns with peak total serum bilirubin levels greater than or equal to 428 micromol/L (> or =25 mg/dL) (n = 73). Controls were a random sample of newborns from the cohort with peak bilirubin levels less than 428 micromol/L (<25 mg/dL) (n = 423). MEASUREMENTS: Review of medical records and telephone interviews. RESULTS: Early jaundice was most strongly associated with case status (odds ratio [OR] = 7.3). After excluding subjects with early jaundice, the strongest predictors of hyperbilirubinemia were family history of jaundice in a newborn (OR = 6.0), exclusive breastfeeding (OR = 5.7), bruising (OR = 4.0), Asian race (OR = 3.5), cephalhematoma (OR = 3.3), maternal age of 25 years or older (OR = 3.1), and lower gestational age (OR = 0.6/week). These variables identified 61% of newborns as very low risk (about 1/4200). However, the risk in the remaining 39% was still low (1/370). More cases (79%) than controls (59%) had newborn length-of-stay and follow-up consistent with the American Academy of Pediatrics guidelines, but phototherapy use within 8 hours of the time that the guidelines recommend was uncommon in both cases (26%) and controls (33%). There were no apparent cases of kernicterus. CONCLUSIONS: Prevention of extreme hyperbilirubinemia may require closer follow-up than is currently recommended by the American Academy of Pediatrics and more use of phototherapy than was observed in this study. To prevent extreme hyperbilirubinemia (> or =428 micromol/L [> or =25 mg/dL]) in 1 newborn, many newborns would need to receive these interventions.

Bilirubin↗

PubMed2004

Long-term lower extremity prosthetic costs in children with traumatic lawnmower amputations.

OBJECTIVES: To evaluate prosthetic costs of pediatric lawnmower amputations; to see if reducing the incidence of pediatric lawnmower amputations could result in significant cost savings; and to consider if a cost analysis could be useful to implement more safety features (voluntarily or legislatively). DESIGN: Pediatric lawnmower amputees from 1980 to 2000 were reviewed to determine age at time of injury, level of amputation, number of prostheses, and lifetime per prosthesis. A standard prosthetic program beginning at amputation and ending at age 18 years was constructed. An aggregate cost was calculated according to the proportion of amputation levels. The cost burden for prosthetic care was estimated from the statistics of US pediatric lawnmower injuries. SETTING: Referral pediatric orthopedic center. PATIENTS: Fifty-three lower extremity amputees with 58 lower extremity amputations at a mean +/- SD age of 4.7 +/- 2.5 years were reviewed. RESULTS: The percentage of amputee children injured by riding lawnmowers was 80%; the percentage injured by riding lawnmowers engaged in reverse was 39%. Prosthetic costs from the time of injury to the age of 18 years range from 73,140 dollars to 116,040 dollars per single lower extremity amputation. With 600 to 650 new childhood amputations per year due to lawnmowers, the new annual burden for prosthetic costs thus ranges from 43.88 to 75.42 million dollars, or (600)(73,140 dollars) to (650)(116,040 dollars). CONCLUSIONS: Further encouragement of lawnmower manufacturers to install improved safety devices (such as those to disengage power while in reverse mode of operation), new research on improved safety measures, and continued promotion of educational campaigns regarding the dangers of children being around and/or operating riding lawnmowers and garden tractors should be pursued. This will result in significant cost savings as well as incalculable health savings.

Amputation, Traumatic↗

PubMed1989

Home oxygen therapy for chronic lung disease in extremely low-birth-weight infants.

Chronic lung disease that requires prolonged oxygen therapy commonly complicates the recovery of extremely low-birth-weight infants (less than 1000 g). We report follow-up data through 18.5 +/- 0.9 (mean +/- SEM) months of age in 30 extremely low-birth-weight infants (birth weight, 783 +/- 24 g; gestational age, 26.0 +/- 0.3 weeks) who were discharged home receiving supplemental oxygen. Oxygen was prescribed to maintain arterial oxygen saturation at 95% or greater. At discharge, postconceptional age was 40.5 +/- 0.6 weeks, and weight was 2220 +/- 50 g. Duration of home oxygen therapy was 4.5 +/- 0.5 months. The mean weight percentile increased from less than 5 to 23 between discharge and the last follow-up. All infants survived; only 6 required hospitalization for acute medical illnesses. We conclude that carefully supervised home oxygen therapy permits the safe early discharge of selected extremely low-birth-weight infants with chronic lung disease.

Body Weight↗