Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Extremities”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,423 records · Page 79Linked to original sources
PubMed1998

A critical reappraisal of indications for fasciotomy after extremity vascular trauma.

OBJECTIVE: To critically reevaluate the indications for fasciotomy in vascular trauma of the extremities. DESIGN: Case-control study. SETTING: Level I trauma center. MATERIALS AND METHODS: One hundred sixty-three vascular injuries to the extremeties were analyzed. Fasciotomy as an adjunct to vascular repair was performed in 45 limbs (28%), based either on the nature of injury or measured compartment pressure of greater than 35 mm Hg. MAIN OUTCOME MEASURES: Need for fasciotomy or limb amputation. RESULTS: Fasciotomy was performed for 29.5% of isolated arterial injuries, 15.2% of isolated venous injuries, and 31.6% of combined arterial and venous injuries, and was not related to venous repair or ligation. Seven delayed fasciotomies were performed either for vascular repair failure (5 patients) or compartment syndrome (2 patients). The highest incidence was for popliteal vessel injury (arterial 57%, combined 61%). Of the 33 lower-extremity fasciotomies, 58% were for popliteal vessel injury. In 51 combined injuries of the lower extremity, only 7 (19%) of 38 patients with injury above the knee required fasciotomy, as compared with 8 (62%) of 13 with injury to the popliteal vessels (P<.001), with or without venous repair. There were 3 amputations, all resulting from vascular repair failure. CONCLUSIONS: The presence of a combined vascular injury or the need for venous ligation does not necessitate routine fasciotomy. The need for fasciotomy may be maximal for injuries to popliteal vessels.

Adolescent↗
PubMed2002

Blunt lower-extremity trauma and popliteal artery injuries: revisiting the case for selective arteriography.

HYPOTHESIS: Abandoning mandatory angiography in patients with blunt lower-extremity trauma and normal neurovascular examination results does not affect limb salvage. DESIGN: Retrospective, nonrandomized cohort study. Mean follow-up (31 of 52 patients) of 9.5 months (range, 0-96 months). SETTING: Single-institution, academic level I trauma center. PATIENTS: Medical records of patients presenting on an emergency basis with knee dislocation, distal femoral fractures, or proximal tibial fractures during a 20-year period were reviewed. Fifty-three injuries occurred in 52 patients. Patients were predominantly male (81%) and young (mean age, 32.7 years). Mechanisms and side of extremity injury, coincident injuries, and neurovascular status on admission were recorded. Hard signs of arterial insufficiency or compartment syndrome were identified. INTERVENTIONS: Angiographic findings and operative and nonoperative interventions were recorded to identify whether angiographic data would alter therapy dictated by clinical findings alone. MAIN OUTCOME MEASURES: Limb salvage rate and necessity for vascular surgical intervention based on angiographic data in patients with normal neurovascular examination results. RESULTS: Multiorgan trauma occurred in 11 patients. Pulses were normal in 35, absent in 16, and diminished or identified by Doppler signal in 2. Arterial insufficiency or compartment syndrome was present in 29%. Twenty-seven patients (28 limbs) underwent angiography at the discretion of the attending surgeon. Of 13 abnormal arteriograms, 2 occurred in patients with normal pulses and 11 in patients with abnormal examination results. Thirteen of 36 patients with normal pulses underwent angiography; none had clinically significant arterial injuries that necessitated intervention. No vascular interventions were necessary in 23 patients with normal pulses who did not undergo angiography (P<.001). Normal neurovascular status bore a 100% negative predictive value in determining the necessity of vascular intervention. CONCLUSIONS: Angiography is unnecessary in the routine evaluation of the patient with blunt lower-extremity trauma who presents with a normal neurovascular examination result and can be used selectively for patients with diminished pulses who lack associated indications for mandatory operative exploration.

Adult↗
PubMed1975

The natural history of bilateral aortofemoral bypass grafts for ischemia of the lower extremities.

Analysis of the immediate and long-term results in 180 patients undergoing aortofemoral bypass grafts for occlusive disease of the lower extremities showed the immediate graft limb patency in 360 graft limbs to be 99.2%. The cumulative ten-year graft limb patency was 66%. Factors associated with thrombosis of the graft limb revealed correlations for localized atherosclerotic disease of either the profunda femoris artery or the tibial trifurcation vessels. The highest correlation for graft limb thrombosis was with simultaneous lesions involving both the profunda femoris artery and tibial trifurcation vessels. The acute lower extremity salvage rate was 94%, and the ten-year cumulative extremity salvage for legs at risk of amputation was 85%. Postoperative symtpoms correlated well with patency. Overall operative mortality was five patients out of 180 (2.5%).

Adult↗
PubMed1976

Pediatric vascular trauma. Manifestations, management, and sequelae of extremity arterial injury in patients undergoing surgical treatment.

Twenty pediatric patients with a mean age of 9.2 years exhibited 21 injuries to arteries of an extremity and underwent operation. Included were 12 iatrogenic injuries and nine non-iatrogenic penetrating injuries. Femoral, brachial, popliteal, radial, axillary, iliac, and tibial arteries were sites of vascular trauma. Long-term follow-up, averaging 36 months, was possible in 14 patients. Postoperative scanograms, digital impedance plethysmographic studies, and bone age roentgenograms were routinely obtained. Limb length disparities greater than 5 mm, extremity blood pressure differentials greater than 10 mm Hg, and bone age retardation were encountered. Proper treatment of pediatric patients with acute arterial injuries of an extremity requires early operative intervention and continuous postoperative follow-up during years of active growth. If chronic arterial insufficiency ensues, arteriographic studies should be obtained and arterial reconstruction undertaken.

Adolescent↗
PubMed1977

Limb-preserving vascular surgery for malignant tumors of the lower extremity.

Monobloc soft-part resections have been carried out with excision of segments of the illac and femoral vessels in seven patients with cancer in the lower extremity. Amputation would have been necessary otherwise. Ischemic loss of the extremity did not occur. In four of the earlier patients, vascular reconstruction was not performed, and postoperative lymphedema was a major complication. In the recently treated three patients, complete reconstitution of the circulation by simultaneous arterial and venous grafting permitted smooth postoperative recovery and absence of notable edema. Creation of a distal arteriovenous fistula appears essential to maintain venous patency. Six of the seven patients are alive at six months, 1, 3, 4, 7, and 18 years, respectively. One patient died of pulmonary metastases at three years after operation. Two patients developed local recurrences requiring limb disarticulation, both in the earlier group in which excision and grafting of both artery and vein was not done. It is concluded that excision and simultaneous reconstruction of major blood vessels can extend the scope of soft-part resections for cancer of the extremities, offering opportunities for preservation of limbs that would otherwise require amputation for control of disease.

Adult↗
PubMed1981

Obliterative arterial disease of the upper extremity.

During the past 20 years, 163 patients had 194 operations for obliterative arterial disease of the upper extremity. Of these, 68 had neurological symptoms primarily that were associated with arterial obstruction of the first portion of the subclavian artery. The remaining 95 patients had ischemic symptoms of the upper extremity, namely, intermittent claudication of the arm or ischemic necrosis of the fingers. There were 95 procedures performed on 90 patients with diminished or absent brachial blood pressures. There were 89 cervical sympathectomies performed on patients whose brachial pressures were equal to the contralateral arm. When sympathectomy was done, results were excellent in patients who had a rise in skin temperature confirmed preoperatively by reflex vasodilation studies. An aggressive approach with early diagnostic arteriography and appropriate surgical therapy is indicated in patients with ischemia to the upper extremity.

Arm↗
PubMed1983

Computed tomographic localization of wooden foreign bodies in children's extremities.

Computed tomographic (CT) scanning accurately can identify and localize deeply embedded wooden foreign bodies in an extremity. Previously, wooden foreign bodies were often difficult to find for surgical removal. Two cases illustrating the accurate identification and localization of troublesome infected wooden foreign bodies in the tissues of extremities of children are presented. The accurate description by CT facilitated a precisely planned removal of these foreign bodies without adjacent tissue damage. This new diagnostic tool is valuable for finding obscure low-density foreign bodies in an extremity.

Child↗
PubMed1983

Phleborheography of the upper extremity.

Phleborheography is a well-established technique for the noninvasive diagnosis of deep venous thrombosis of the lower extremity. For ten years we have used phleborheography in the diagnosis of axillary and subclavian venous thrombosis. We developed modifications in technique and interpretation that are necessary for accurate application of phleborheography to the upper extremity. When compared with venography, the sensitivity and specificity of this technique approached 90%. Therefore, phleborheography appears to be a useful screening examination for deep venous thrombosis of the upper extremity.

Axillary Vein↗
PubMed1995

The influence of race on the use of surgical procedures for treatment of peripheral vascular disease of the lower extremities.

OBJECTIVE: To assess whether rates of amputation and leg-sparing surgery for peripheral vascular disease of the lower extremities differ between African-American and white patients. DESIGN: Retrospective cohort study using Medicare claims data for 1989 and 1990. SETTING: A total of 3313 hospitals in the United States. PATIENTS: Random sample of 19,236 Medicare Part A enrollees who underwent amputation and/or leg-sparing surgery for peripheral vascular disease. MAIN OUTCOME MEASURES: Adjusted odds of toe and/or foot amputation, below-knee amputation, above-knee amputation, lower extremity arterial vascularization, and percutaneous transluminal angioplasty for African American relative to whites, controlling for case-mix, region, and hospital characteristics. RESULTS: African-American patients were significantly more likely than white patients to undergo above-knee, below-knee, and toe and/or foot amputation and significantly less likely to undergo lower-extremity arterial revascularization and percutaneous transluminal angioplasty. These associations occurred for diabetic patients and nondiabetic patients but were more pronounced among patients who did not have diabetes. CONCLUSIONS: Potential explanations include unmeasured factors such as severity of disease and the technical expertise available at hospitals or other factors such as lack of compliance with medical treatment and race-specific treatment decisions by providers. Whatever the cause, interventions aimed toward reducing the number of amputations among African Americans are needed. Further work is required to determine where such interventions should be targeted.

Black or African American↗
PubMed1996

Vascular reconstruction for limb salvage in sarcoma of the lower extremity.

OBJECTIVES: To examine the patency and limb-salvage characteristics of vascular reconstruction in patients with sarcomas of the lower extremity who had been treated with limb-preserving resection and to examine patient survival during a long follow-up period. DESIGN: Retrospective cohort study. SETTING: University hospital, tertiary referral center. PATIENTS: From 1984 to 1992, 14 patients underwent limb-preserving resection of sarcomas in the proximal lower extremity, with 20 vascular reconstructions performed. OUTCOME MEASURES: Color Doppler scans documented patency of the vascular reconstructions. Clinical evaluation included functional results in terms of limb movement and quality of life. Local tumor control and systemic recurrence were examined by repeated radiologic examination. Overall survival as well as time and cause of death were assessed. RESULTS: A total of 13 patients had patent vascular grafts, while the venous graft became occluded in 1 patient. Limb function was rated as excellent or good in 9 patients, as fair in 3, as poor in 1, and could not be clinically estimated in 1. Postoperative thrombosis of the venous graft was detected in 3 patients and was effectively managed by thrombectomy in 2. Three patients underwent reoperation because of hematoma or complications caused by local infection. The tumor endoprosthesis had to be replaced in 3 patients. During follow-up periods that ranged from 15 to 132 months (mean, 55 months), 4 patients died. In all of these patients the cause of death was systemic recurrence in the lung. Two additional patients developed pulmonary metastases, but at the time of this report, they were still alive as long as 132 months after operative resection or chemotherapy. No local recurrence was found. CONCLUSION: Limb-preserving resection of sarcoma of the lower extremity can be performed with satisfactory function of the limb maintained, even if it becomes necessary to resect the femoral vessels. Autologous venous graft for vascular reconstruction is the treatment of choice. In spite of the high incidence of metastases, considerable long-term survival is possible.

Adolescent↗
PubMed1997

Upper extremity ischemia from subclavian artery aneurysm caused by bony abnormalities of the thoracic outlet.

OBJECTIVE: To describe our experience with surgical therapy for upper extremity ischemia incident to emboli from aneurysms of the subclavian artery. DESIGN: Retrospective review case series. SETTING: Vascular surgery practice at a university hospital-based tertiary referral center. PATIENTS: All patients treated for upper extremity ischemia caused by embolism from a subclavian artery aneurysm from January 1, 1990, to July 31, 1996. INTERVENTION: All patients underwent detailed history and physical examination, screening for immunologic and hypercoaguable disorders, noninvasive vascular laboratory evaluation, and arteriography of the aortic arch in both arms and hands. Surgical treatment consisted of rib excision or fracture plating, aneurysm excision, and interposition vein grafting, with additional saphenous vein bypasses to brachial or forearm arteries as needed to provide uninterrupted circulation to the wrist. RESULTS: Twelve patients (6 males; mean age, 37 years) were treated. All had episodic upper extremity ischemia with an initial misdiagnosis of primary vasospastic disorder. Rest pain and/or ischemic ulceration developed in 3. Duration of symptoms before correct diagnosis averaged 7 months (range, 1-36 months). All patients had bony abnormalities of the thoracic outlet (8 cervical ribs, 3 abnormal first ribs, and 1 unstable clavicular fracture). All aneurysms contained intraluminal thrombus, and all patients had multiple ipsilateral distal arm, forearm, and/or hand arterial occlusions indicating chronic and repeated embolization. All patients underwent aneurysm excision and interposition vein grafting, with additional vein bypass to the brachial (3 patients) and/or forearm arteries (5 patients). Mean follow-up was 18 months (range, 2 weeks to 63 months). Eleven patients had complete symptomatic relief, and 1 patient improved. All subclavian interposition grafts remained patient. Two distal bypass grafts occluded in patients with preoperative arteriograms demonstrating no patient forearm arteries. There has been no limb loss. CONCLUSIONS: Hand ischemia caused by embolization from a subclavian artery aneurysm occurs in young patients without atherosclerosis and is frequently misdiagnosed as vasospasm. Despite advanced disease and multiple chronic distal arterial occlusions, surgical treatment by resection of bony abnormalities, aneurysm excision and grafting, and distal bypass grafting produces excellent results.

Adolescent↗
PubMed1997

Long-term results of lower-extremity venous injuries.

OBJECTIVES: To compare the long-term venous function of ligated, simple, and complex repairs and to assess long-term patency in repaired veins. DESIGN: A cohort study of patients with lower-extremity venous injuries treated during a 7-year period. SETTING: A level I urban trauma center. PATIENTS: Twenty-one of the 79 patients with a history of lower-extremity venous injury identified via the trauma registry consented to outpatient evaluation. INTERVENTION: Participating patients underwent a through vascular examination that included color flow duplex venous imaging and air plethysmographic assessment. MAIN OUTCOME MEASURES: The patency of venous repairs, the incidence of chronic deep venous thrombosis, and evidence of chronic venous insufficiency. RESULTS: The venous injuries included 5 iliac, 10 femoral, and 6 popliteal. Six of these injuries were ligated, 11 injuries were simply repaired (lateral venorrhaphy or end-to-end), and 4 were repaired with complex interposition grafts. All repairs were patent, with no evidence of deep venous thrombosis by color flow duplex venous imaging. Seventeen of the 21 patients had symptoms, color flow duplex venous imaging findings, and air plethysmographic data consistent with chronic venous insufficiency, including significant mean differences (P < .03) in outflow fraction, outflow fraction with compression, venous filling index, and residual volume fraction, when compared with the uninjured extremity. The most profound changes followed complex repairs and perioperative fasciotomies. CONCLUSIONS: While the long-term patency of venous repairs is excellent, most patients demonstrate evidence of chronic venous insufficiency after either ligation or repair. Complex venous repairs and fasciotomy are associated with the most severe functional changes.

Adult↗
PubMed2000

Metastases to the retroperitoneum in patients with extremity soft tissue sarcoma: an unusual metastatic pattern.

BACKGROUND: Extremity soft tissue sarcoma (STS) metastasizes preferentially to the lungs via the hematogenous route. Metastases in extrapulmonary sites such as bone, brain, and subcutaneous tissues are observed less frequently. To the authors' knowledge, limb STS primarily metastasizing to the retroperitoneum has not been described to date. The current study reviews the clinical course, management, and patient prognosis in such a pattern of metastasis. METHODS: Records of patients with retroperitoneal metastases originating from an extremity STS between 1994-1998 were reviewed. Patient demographics, primary tumor site, other tumor sites, local recurrence, distant metastasis, treatment, and survival were analyzed. RESULTS: Ten patients were included in the study. All had primary STS of different histologic types and high histologic grade confined to a lower limb. The retroperitoneal metastases were diagnosed between 6-120 months (mean, 45 months) after diagnosis of the primary sarcoma. At that time, one patient had evidence of local recurrence of the primary tumor site, two patients had lung metastases, and one patient had diffuse bone metastases. Eight patients were eligible for surgery. In six of these patients the metastases were excised completely. The median follow up was 12 months. Of the six patients who underwent complete resection, 3 were alive at last follow-up with no evidence of disease after 12 months, 14 months, and 24 months, respectively. Two patients with recurrent retroperitoneal disease and one patient with retroperitoneal and lung metastases died despite systemic chemotherapy. CONCLUSIONS: Extremity STS can metastasize hematogenously to the retroperitoneum, a fact that mandates a high index of suspicion and abdominal imaging studies during the follow-up of such patients. Retroperitoneal metastases necessitate aggressive surgical resection to enable prolongation of survival.

Adult↗
PubMed2000

Outcomes in work-related upper extremity and low back injuries: results of a retrospective study.

BACKGROUND: The outcomes of treatment for work-related injuries and illnesses are multidimensional and complex, but have rarely been explored in detail. This study was intended to provide information on a sample of workers representing a range of jobs and employers typical of the workers compensation system. METHODS: A mailed, self-report survey measuring multiple dimensions was conducted. Identified through the New Hampshire Division of Workers' Compensation First Report of Injury database, a sample of workers with injuries to their lower back (60%) or upper extremities (40%) a year prior to the study were surveyed. Response rate was 80% (N=169; upper extremity cases=70; low back cases=99). RESULTS: Most (82.8%) were working one year post-injury. Over half reported residual effects of the injury on work or activities of daily living. Many working subjects reported persistent injury-related anxiety and pain at the end of the work day, worse in those with low back pain compared to those with upper extremity injuries. Almost 40% of those who returned to work suffered a reinjury. Forty-four percent of respondents suffered significant injury-related financial problems, which were worse in those who had been out of work for longer periods. CONCLUSIONS: Occupational musculoskeletal injuries do result in significant, long-term adverse physical, economic, and psychological consequences, as demonstrated in self-reported surveys.

Absenteeism↗
PubMed2000

A comparison of approaches to modeling the relationship between ergonomic exposures and upper extremity disorders.

BACKGROUND: For a study of upper extremity musculoskeletal disorders among automobile manufacturing workers, an ergonomic exposure index was constructed by summing ten psychophysical (interview) items. Here we explore the sensitivity of the exposure-response relationship to the formulation of that index. METHODS: Five alternative exposure indices were constructed: three a priori weighting schemes and two sets of weights derived from multivariate regression coefficients. In addition, structural equation modeling was performed with LISREL. RESULTS: The original index and a priori weighting schemes had similar associations with upper extremity disorders, adjusted for nonoccupational covariates. A reasonable model fit was achieved in LISREL after two modifications; the standardized solution showed that nonneutral postures were significantly related to upper extremity signs and symptoms. CONCLUSIONS: In this large population, with adequate range of exposures, the exposure-response relationship appeared generally robust to the mathematical formulation of the exposure index. Among the available exposure variables, postural strain had the strongest association.

Adult↗
PubMed1997

Thermogenic, respiratory, and ultrasonic responses of week-old rats across the transition from moderate to extreme cold exposure.

Previously, it was reported that week-old rats exposed to air temperatures that elicited submaximal levels of heat production (designated moderate cold exposure) remained asleep and did not vocalize (Blumberg & Stolba, 1996). In contrast, pups exposed to air temperatures that elicited maximal levels of heat production (designated extreme cold exposure) woke up and emitted ultrasonic vocalizations. We now report on the physiological and behavioral responses of pups in the transitional region between moderate and extreme air temperatures. Small decreases in air temperature across the transition resulted in pronounced decreases in physiological temperature and concomitant increases in ultrasound production. In a second experiment, it was shown that during moderate cold exposure respiratory frequency increased as air temperature decreased but, as extreme air temperatures were reached, respiratory frequency was maximized as ultrasound production began. The results from these two experiments illustrate how air temperatures that differ by as little as 2 degrees C can differentially modify the physiological and behavioral responses of neonates.

Animals↗
PubMed2000

A comparison of staging systems for localized extremity soft tissue sarcoma.

BACKGROUND: Staging systems for soft tissue sarcoma (STS) are important to identify patients with similar systemic risk who might benefit from specific treatments. This study compared four commonly used staging systems for predicting systemic outcomes of patients with localized extremity STS, as proposed by the fourth and fifth editions of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system, the Memorial Sloan-Kettering Cancer Center (MSK) system, and the Surgical Staging System (SSS) of the Musculoskeletal Tumor Society. METHODS: Three hundred consecutive adult patients with newly diagnosed nonmetastatic STS of the lower extremity were treated at Memorial Sloan-Kettering Cancer Center between 1982 and 1989. Metastasis free survival was the end point of the study. The prognostic value of the four staging systems and their components were examined in univariate and multivariate analyses. The Akaike information criterion (AIC) was used to identify the system that best predicted the risk of systemic recurrence. RESULTS: Compartment status, depth, grade, and size were all independent predictors of outcome within their respective staging systems. However, when compared with one another, only depth, grade, and size retained their prognostic significance. Of the four models, the AIC predicted that the MSK was the best predictor of systemic relapse, followed by the fifth edition of the AJCC/UICC staging system. CONCLUSIONS: Staging systems such as the MSK system or the fifth edition of the AJCC/UICC system, which include tumor depth, grade, and size as prognostic factors, are the most predictive of systemic relapse in patients presenting with localized extremity STS. Both of these systems identify the same group of patients at the highest risk who would be the most suitable for adjuvant chemotherapy trials.

Adolescent↗
PubMed2001

Prevalence and risk factors of tendinitis and related disorders of the distal upper extremity among U.S. workers: comparison to carpal tunnel syndrome.

BACKGROUND: National estimates of tendinitis and related disorders of the distal upper extremity among U.S. workers have not been available with the exception of carpal tunnel syndrome. METHODS: The Occupational Health Supplement Data of the 1988 National Health Interview Survey were analyzed for tendinitis and related disorders of the hand/wrist and elbow (distal upper extremity) using the Survey Data Analysis (SUDAAN) software. RESULTS: Among the 30,074 respondents (statistically weighted population of 127 million) who had worked anytime during the previous 12 months, 0.46% (95% CI: 0.36, 0.56) reported that they experienced a "prolonged" hand discomfort which was called tendinitis, synovitis, tenosynovitis, deQuervain's disease, epicondylitis, ganglion cyst, or trigger finger, by a medical person. This corresponds to 588,000 persons (95% CI: 457,000; 712,000) reporting one of these disorders, 28% (or 164,000) of which were thought to be work-related by the medical person. Among various risk factors examined by multiple logistic regression analysis, bending/twisting of the hands/wrists at work and female gender were significantly associated with reporting of these disorders. CONCLUSIONS: By combining these cases with the previously reported cases of work-related carpal tunnel syndrome, we estimate that there were approximately 520,000 cases of work-related musculoskeletal disorders of the distal upper extremity among US workers in 1988.

Adolescent↗