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PubMed2002

Cell cycle reentry of ventricular and atrial cardiomyocytes and cells within the epicardium following amputation of the ventricular apex in the axolotl, Amblystoma mexicanum: confocal microscopic immunofluorescent image analysis of bromodeoxyuridine-labeled nuclei.

To understand how to reinitiate cell division in adult human myocardium, a heart regeneration model was examined in the amphibian axolotl salamander, Amblystoma mexicanum. The ventricular apex was surgically amputated and resected for 3 weeks. At 14 days of recovery, the thymidine analog 5-bromo-2'-deoxyuridine (BrdU) was injected intraperitoneally to identify cell types undergoing S-phase by indirect immunofluorescence using primary anti-BrdU antibodies. This is the first report showing a concentrated area of cell division in the ventricle and cells throughout the atrial epicardium by confocal microscopic image analysis in response to wounding of the ventricle. Tissues coimmunostained with anti-BrdU and sarcomeric myosin-specific MF20 antibodies showed 12.8 +/- 4.10% of myocytes contained BrdU(+) nuclei in a 75 microm to 750 microm zone in the ventricular myocardium subjacent to the amputation plane. BrdU(+) nuclei also were present in newly formed ventricular epicardium that surround dividing myocytes, and in epicardial mesothelium (74.3 +/- 6.36 %) and connective tissue (44.9 +/- 13.31%) cells distal to the wound. Unexpectedly, immunofluorescent BrdU(+) nuclei were observed in isolated atrial myocytes (13.9 +/- 1.45%) and in uninjured atrial epicardial mesothelium (64.3 +/- 1.55%) and connective tissue (29.4 +/- 5.50%). No BrdU(+) nuclei were present in cardiomyocytes or epicardium from sham-operated and BrdU-treated controls. These results suggest that renewed cell division is a specific response to wounding of the ventricle. Additionally, release of a growth factor may be responsible for the specific localized mitotic ventricular cardiomyocyte response adjacent to the wound, and the more generalized atrial proliferative response distal to the amputation.

Ambystoma mexicanum↗
PubMed1995

Providing an environment for reparative dentine induction in amputated rat molar pulp by high molecular-weight hyaluronic acid.

To study provision of this environment, wound healing was examined by light and electron microscopy following pulp amputation and direct capping with hyaluronic acid. Molar pulps of female Sprague-Dawley rats were mechanically exposed and directly capped; the cavities were then restored with glass-ionomer cement. As an experimental control. Calvital (a commercial preparation of calcium hydroxide paste) was used as the direct pulp-capping agent in other rats, and its effect on pulp healing was compared with that of hyaluronic acid. In hyaluronic acid-treated pulps, at 2 days after amputation, wound surfaces were covered with blood and fibrin clots and inflammatory cells such as neutrophils and macrophages. At 1 week, differentiation of fibroblastic and odontoblast-like cells was observed beneath the wound layer; and odontoblast-like cells produced globular calcified nodules along the existing dentine walls. At 2 weeks, a layer of reparative dentine had been formed by odontoblast-like cells over the dentine walls. Between 30 and 60 days, the formation of reparative dentine had extended throughout the pulp chamber. The healing observed after direct capping with hyaluronic acid was, except for the formation of dentine bridges, similar to that seen after Calvital capping. These results suggest that high molecular-weight hyaluronic acid can provide an environment suitable for reparative dentine formation through mesenchymal cell differentiation during healing of the amputated dental pulp.

Animals↗
PubMed2006

[Rectal amputation by pure perineal approach with laparoscopic colostomy: a palliative therapeutic option for low rectal or anal cancers for elderly patients with multiple comorbidities].

Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is prevented and treated by surgical resection. But, for old patients with multiple tares, carcinologic surgical resection as abdominoperineal amputation can not be considered. Management of rectal syndrome becomes a therapeutic challenge. We reported a prospective serie of 5 patients more than 80 years old with multiple tares, treated by rectal amputation by pure perineal approach with laparoscopic colostomy. This surgery avoided for all patients trying rectal symptoms and maintained acceptable quality of life with fast coming back at home. The palliative treatment of low rectal cancers or anal cancers combining rectal amputation by pure perineal approach with laparoscopic colostomy may be an interesting therapeutic option for patients who cannot undergoing aggressive carcinologic surgical treatment.

Aged↗
PubMed2006

Functional status and factors influencing the rehabilitation outcome of people affected by above-knee amputation and hemiparesis.

OBJECTIVES: To evaluate the functional status of people with transfemoral amputation and hemiparesis and to identify the factors that influence rehabilitation outcome after inpatient treatment. DESIGN: Retrospective study. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-five patients (30 men, 15 women; mean age, 69+/-9y) with intact mental status affected by unilateral transfemoral amputation for vascular disease and mild or moderate hemiparesis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Barthel Index effectiveness, and Locomotor Capabilities Index (LCI) scores were measured. The following factors were studied: side and cause of amputation, side and severity of hemiparesis, sequence and laterality of dual impairment, time interval between impairments, and hospital length of stay. RESULTS: At discharge, mean Barthel Index and LCI scores +/-1 standard deviation were 79+/-12 and 15+/-5.6, respectively; Barthel Index effectiveness was 55+/-23.8. Only 2 patients ambulated without walking aids. Barthel Index effectiveness was better in patients with mild hemiparesis than in patients with more severe impairment. Ipsilateral localization of dual impairment increased the probability of higher LCI scores. CONCLUSIONS: Selected patients with dual impairment can recover the ability to walk. Severity of hemiparesis and laterality were the 2 clinical factors that had the greatest influence on functional measures.

Activities of Daily Living↗
PubMed2005

Joint loading and bone mineral density in persons with unilateral, trans-tibial amputation.

BACKGROUND: Persons with unilateral, lower-extremity amputation sometimes develop osteoarthritis in the intact limb. The purpose of this study was to investigate gait mechanics and bone mineral density in unilateral, trans-tibial amputees to test the hypotheses that the intact limb knee and hip will have larger frontal plane net joint moments and bone mineral density than the prosthetic side and the limbs of control subjects. METHODS: Proximal tibia and femoral neck bone mineral density and gait mechanics were measured from nine subjects with a unilateral, trans-tibial amputation and from age, gender, and mass matched control subjects. FINDINGS: The amputee intact proximal tibia bone mineral density and peak knee internal abduction moment were 45% (P=0.001) and 56% (P=0.028) greater, respectively, than the prosthetic side. The intact limb femoral neck bone mineral density and peak hip internal abduction moment were 12% (P=0.095) and 33% (P=0.03) greater, respectively, than the prosthetic side. The intact knee frontal plane moment and bone mineral density were moderately larger than the control knee, while the intact and control hip were similar. INTERPRETATION: Elevated frontal plane net joint moments and bone mineral density suggest the potential exists for premature knee joint degradation. Measuring frontal plane joint mechanics and bone mineral density may be important tools for assessing joint health in persons with unilateral, trans-tibial amputation.

Adult↗
PubMed1999

Sprint kinematics of athletes with lower-limb amputations.

OBJECTIVE: To determine and compare the kinematics of the sound and prosthetic limb in five of the world's best unilateral amputee sprinters. SUBJECTS: Five men, all unilateral lower-limb amputee (one transfemoral, four transtibial) athletes. The individual with transfemoral amputation used a Endolite Hi-activity prosthesis incorporating a CaTech hydraulic swing and stance control unit, a Flex-Foot Modular III, and an ischial containment total contact socket. Those with transtibial amputations used prostheses incorporating a Flex-Foot Modular III and patellar tendon-bearing socket, with silicone sheath liner (Iceross) and lanyard suspension. DESIGN: Case series. Subjects were videotaped sprinting through a performance area. Sagittal plane lower-limb kinematics derived from manual digitization (at 50 Hz) of the video were determined for three sprint trials of the prosthetic and sound limb. Hip, knee, and ankle kinematics of each subject's sound and prosthetic limb were compared to highlight kinematic alterations resulting from the use of individual prostheses. Comparisons were also made with mean data from five able-bodied men who had similar sprinting ability. RESULTS: Sound limb hip and knee kinematics in all subjects with amputation were comparable to those in able-bodied subjects. The prosthetic knee of the transfemoral amputee athlete fully extended early in swing and remained so through stance. In the transtibial amputee athletes, as in able-bodied subjects, a pattern of stance flexion-extension was evident for both limbs. During stance, prosthetic ankle angles of the transtibial amputee subjects were similar to those of the sound side and those of able-bodied subjects. CONCLUSION: Prosthetic limb kinematics in transtibial amputee subjects were similar to those for the sound limb, and individuals achieved an "up-on-the-toes" gait typical of able-bodied sprinting. Kinematics for the prosthetic limb of the transfemoral amputee subject were more typical of those seen for walking. This resulted in a sprinting gait with large kinematic asymmetries between contralateral limbs.

Adult↗
PubMed2005

[Post-cholecystectomy amputation neuroma of the common bile duct with obstructive jaundice].

Amputation neuroma of the common bile duct after surgery is a rare and mostly asymptomatic lesion. A 60-year old patient presented with obstructive jaundice three months after a cholecystectomy for symptomatic gallstones. Imaging investigations showed common extrahepatic bile duct stenosis. Surgical resection of the stricture with biliodigestive anastomosis was performed. Histological examination of the surgical specimen revealed an amputation neuroma. Despite its rarity, amputation neuroma of the common bile duct should be considered in patients with post-cholecystectomy syndrome following liver or extrahepatic bile duct surgical procedures.

Cholecystectomy↗
PubMed1996

Laparoscopic-assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by trachelectomy.

Since most abdominal hysterectomies are performed for treatment of large uterine fibroids, an effective laparoscopic approach must be discovered for the endoscopic treatment of large uterine fibroids. We performed a retrospective analysis of all laparoscopic-assisted vaginal hysterectomies (LAVHs) we performed on uteri that were both greater than 12 weeks' size on preoperative examination and heavier than 450 g on pathologic evaluation. Twenty cases fulfilled the selection criteria, with mean uterine weight of 709 g and operating time of 178 minutes. Two surgical approaches were compared. Group 1 (5 women) consisted of LAVH without supracervical amputation with mean operating time of 216 minutes. Group 2 (15 women) consisted of laparoscopic supracervical amputation followed by vaginal trachelectomy with mean operating time of 165 minutes. Our results suggest that laparoscopic supracervical amputation can enhance the laparoscopic management of large uterine fibroids.

Cervix Uteri↗
PubMed2004

Syme and his amputation.

The study examines Syme's indications for and technique of amputation at the ankle and reviews the outcome of cases operated on by him for the years 1841-1866. Sources are the Ward Journals and the General Registers of Patients of the Royal Infirmary of Edinburgh for the period under review together with abstracts from contemporary medical journals and surgical textbooks. Ninety-eight cases are included in the study, of which 87 survived and 11 died in the post-operative period. The principal indication for this amputation was 'caries' and the nature of this disorder is outlined. Syme's operative technique is described together with variations recommended by other contemporary surgeons. Syme introduced amputation at the ankle joint with the object of reducing mortality and providing a better stump in cases of disease and injury to the foot. The figures from this study conclude that he was justified on both counts.

Ankle Joint↗
PubMed1997

Limb amputation in amniotic band syndrome: serial ultrasonographic and Doppler observations.

A 28-year-old woman, gravida 7, para 6, was referred at 21 weeks' gestation to our ultrasound unit because of bilateral fetal lower limb edema diagnosed previously. Ultrasonography showed a constriction ring around both legs, and, with the aid of color Doppler, arterial flow was demonstrated in both legs beneath the constriction ring. Subsequent examinations during the 24th and 28th weeks revealed absence of flow below the constriction ring of the right leg and decreased flow in the left leg. This was followed by the gradual bending, breaking and resorption of the tibia and fibula of the right leg. Between weeks 30 and 34, gradual shrinkage of the remains of the right leg beneath the knee was recorded by serial ultrasonic observations. At the 38th week of gestation, a male infant was born by normal vaginal delivery. Examination at birth revealed amputation of the right leg below the knee, with a denuded end of the stump. There was a partial amputation of the left leg below the knee, with tissue continuity being maintained by the posterior neurovascular bundle, and a posterior strip of skin. The left foot was extremely edematous, with an area of necrosis dorsally. This case afforded us the opportunity of in utero following of natural limb amputation in the amniotic band syndrome.

Adult↗
PubMed1985

Distal revascularization and microvascular free tissue transfer: an alternative to amputation in ischemic lesions of the lower extremity.

Most lower extremity amputations result from complications of diabetes and arterio-sclerotic occlusive diseases below the inguinal ligament. Improved limb salvage has been achieved by an aggressive approach to distal revascularization in the severely ischemic lower extremity. There remains, however, a high incidence of amputation resulting from progression of the ulceration or gangrene into deeper and less well-vascularized tissues, such as tendon and bone. Even in the nonischemic extremity, such wounds rarely heal without flap coverage. Microvascular free tissue transfers promote healing by providing coverage with healthy, nondiseased, well-vascularized tissue for these difficult defects. Successful free flap transfer requires a high-pressure recipient inflow vessel. In contrast to individuals with nonarteriosclerotic lesions, many individuals with nonhealing ischemic lesions have no acceptable artery demonstrated on high-resolution angiography to serve as a recipient vessel. Limb salvage has been achieved in four candidates for amputation utilizing distal revascularization followed by free tissue transfer coverage of the ischemic lower leg defects.

Aged↗
PubMed2001

Orbital amputation neuroma causing failure of prosthesis wear.

PURPOSE. To describe an orbital amputation neuroma that developed following enucleation and led to the patient 's inability to wear an oc- ular prosthesis. METHODS. This is a retrospective case report in a private practice setting. An elderly woman underwent enucleation of the right eye,and subsequently developed orbital pain and inflammation. Systemic and local steroids proved of no benefit, and the socket became increasingly painful,contracted and frozen. She was unable to wear her prosthesis. An orbital mass was noted,and subsequently biopsied. RESULTS. The biopsy specimen demonstrated orbital amputation neuroma. Her pain was relieved. CONCLUSION. Orbital amputation neuroma should be a diagnostic con- sideration when a patient develops a painful orbital mass following enucleation.

Journal Article↗
PubMed1973

Effects of calcium ion concentration on the degeneration of amputated axons in tissue culture.

Light and electron microscope studies were conducted on the nature of the degenerative changes in amputated nerve fibers of cultured rat sensory ganglia and on the effects of media with differing calcium concentrations upon these changes. With glucose-enriched Eagle's media (MEM) containing 1.6 mM calcium, the amputated myelinated and unmyelinated axons undergo a progressive granular disintegration of their axoplasm with collapse and fragmentation of myelin sheaths between 6 and 24 h after transection. With MEM containing only 25-50 microM calcium, the granular axoplasmic degeneration does not occur in transected fibers and they retain their longitudinal continuity and segmental myelin ensheathment for at least 48 h. Addition of 6 mM EGTA to MEM (reducing the estimated Ca(++) below 0.3 microM) results in the structural preservation of both microtubules and neurofilaments within transected axons. A transient focal swelling of amputated axons occurs, however, in cultures with normal and reduced calcium. These observations suggest that an alteration in the permeability of the axolemma is a crucial initiating event leading to axonal degenerative changes distal to nerve transection. The loss of microtubules and neurofilaments and the associated granular alterations of the axoplasm in transected fibers appears to result from the influx of calcium into the axoplasm.

Animals↗
PubMed1997

Phantom limbs in people with congenital limb deficiency or amputation in early childhood.

It is widely believed that people who are congenitally limb-deficient or suffer a limb amputation at an early age do not experience phantom limbs. The present study reports on a sample of 125 people with missing limbs and documents phantom experiences in 41 individuals who were either born limb-deficient (n = 15) or underwent amputation before the age of 6 years (n = 26). These cases provide evidence that phantom limbs are experienced by at least 20% of congenitally limb-deficient subjects and by 50% of subjects who underwent amputations before the age of 6 years. The phantoms are detailed and can be described in terms of size, shape, position, movement and temporal properties. The perceptual qualities of the phantoms can also be described by sensory descriptors and are reported as painful by 20% of subjects with phantoms in the congenital limb deficient group and 42% of young amputees. It is argued that these phantom experiences provide evidence of a distributed neural representation of the body that is in part genetically determined.

Adolescent↗
PubMed1998

Validity and reliability of measurements obtained with an "activity monitor" in people with and without a transtibial amputation.

BACKGROUND AND PURPOSE: In this study, the validity and reliability of measurements obtained with an "Activity Monitor" (AM) were examined. The instrument is designed to monitor ambulatory activity by use of accelerometer signals, and it detects several activities associated with mobility (standing, sitting, lying, transitions, movement-related activities). SUBJECTS: Four men with a transtibial amputation and 4 men without a transtibial amputation participated. METHODS: The subjects performed normal daily activities, during which accelerations were measured and videotape recording were made (reference method). Validity was assessed by calculating agreement scores between the AM output and the videotape recordings and by comparing the number of transitions and the duration of activities determined by both methods. RESULTS: The overall agreement between the AM output and the videotape recordings was 90%. Other agreement scores, in addition to the determination of the number of transitions and the duration of activities, were generally within a range of error of 0% to 10%. CONCLUSION AND DISCUSSION: The reliability and validity of the AM measurements appeared to be good, which supports its potential use in rehabilitation and physical therapy. [Bussmann HBJ, Reuvekamp PJ, Veltink PH, et al. Validity and reliability of measurements obtained with an "Activity Monitor" in people with and without a transtibial amputation.

Activities of Daily Living↗
PubMed1985

Replantation of digits amputated at or about the distal interphalangeal joint.

Sixty-four digits amputated at or distal to the distal interphalangeal joint were reimplanted in 57 patients with the use of microsurgical techniques. Five patients were children under 3 years of age. The percentage of survival was 96.9%. Before the operation, the surgical anatomy of the amputated digits was studied and particular attention was focused on the microvasculature. Equal emphasis was given to the reinnervation and revascularization of the amputated digits.

Adolescent↗
PubMed1985

Replantation of avulsively amputated thumb: a report of 15 cases.

Since 1978 a series of 15 avulsively amputated thumbs were replanted with survival of the replantation in 14 patients. Good restoration of sensory and motor functions for these patients eradicates the old concept that replantation for avulsively amputated digits is contraindicated or a poor risk. We emphasize the importance of proper management of the transfer technique of the severed tendons, nerves, and blood vessels during the replantation. Details are described. The only failure was a result of technical faults. We conclude that replantation of an avulsively amputated thumb is worthwhile and will be beneficial to the patient.

Adolescent↗
PubMed1998

A temporal analysis of the effects of pressurized oxygen (HBO) on the pH of amputated muscle tissue.

The effect of hyperbaric oxygen (HBO) on ischemic muscle tissue pH was evaluated continuously. The hind limbs of male Sprague-Dawley rats (N=11, both groups) were amputated and stored in room air (20.1% oxygen [O2], 1.0 ATM, 24 degrees C) or in HBO (100% O2, 2.9 ATM, 24 degrees C) for 240 minutes. Rat muscle tissue pH was continuously monitored with a micro-pH electrode following amputation. There was no significant difference between the average starting tissue pH of control and treated limbs (p=0.45). At 240 minutes of ischemia the control group tissue pH decreased 0.80 pH units whereas the treatment group decreased 0.68 pH units (p < 0.05). The tissue pH of control limbs declined 30.7 times faster than treated limbs during the first 36 minutes of ischemia (p < 0.05). From 36 to 240 minutes the rates of acidosis were similar and did not differ significantly (p=0.46). In a separate study, male Sprague-Dawley rats were anesthetized with pentobarbital and ketamine. Aortic arterial blood gases were obtained at 5 minutes (N=8) and 15 minutes (N=8) postanesthesia. The average serum pH, carbon dioxide, oxygen, and bicarbonate levels remained within normal limits in both groups and did not differ significantly (p > 0.05 for all parameters). Anesthesia produced no serum respiratory or metabolic acidosis and did not contribute to the initial ischemic tissue pH. These results suggest that HBO delays the progression of metabolic acidosis in this amputated limb model. This is further supporting evidence for the tissue-preserving effect of oxygen when delivered in hyperbaric conditions. However, the clinical application of this technique may be limited due to the difference in the volume of tissue presented for major limb replantation and the short window of beneficial effects.

Acidosis↗