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Limb preservation

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https://www.readbyqxmd.com/read/28229172/external-beam-radiation-therapy-combined-with-limb-sparing-surgery-in-elderly-patients-70%C3%A2-years-with-primary-soft-tissue-sarcomas-of-the-extremities-a%C3%A2-retrospective-analysis
#1
Claudia Andrä, Alexander Klein, Hans Roland Dürr, Josefine Rauch, Lars Hartwin Lindner, Thomas Knoesel, Martin Angele, Andrea Baur-Melnyk, Claus Belka, Falk Roeder
PURPOSE: To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS). METHODS: Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%...
February 22, 2017: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
https://www.readbyqxmd.com/read/28228367/blockade-of-hmgb1-preserves-vascular-homeostasis-and-improves-blood-perfusion-in-rats-of-acute-limb-ischemia-reperfusion
#2
Yang Liu, Changyou Zhou, Jianjun Jiang, Qingbo Su, Xiangjiu Ding
Acute limb ischemia is one of the most common peripheral arterial disease, while surgical restoration of blood flow often results in ischemia/reperfusion (I/R) injury. Our previous study revealed the inflammation intensity in arterial tissue, characterized by expression of high mobility group box protein 1 (HMGB1), was contrary to the fluctuation of hemodynamics in reperfusion limbs in a rat model. This study meant to clarify the role of HMGB1 during this process. Laser Doppler perfusion imaging evaluated limb hemodynamics in mean and max perfusion unit (PU)...
February 19, 2017: Microvascular Research
https://www.readbyqxmd.com/read/28222622/management-of-acute-achilles-tendon-rupture-with-tendon-bundle-technique
#3
Chun-Guang Li, Bing Li, Yun-Feng Yang
Objective * These authors contributed equally to this work. To explore tendon-bundle technique for treating Achilles tendon rupture with no defects. Methods Patients with full unilateral Achilles tendon rupture with no defects were included. The Achilles tendon medial edge surgical repair approach was used, revealing horsetail-like rupture bundles. Tendon bundles were anatomically realigned and repaired end-to-end using 5-0 sutures. Patients were followed-up for 1 year, and assessed for differences between the repaired versus healthy limb...
February 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28222055/ex-situ-perfusion-of-human-limb-allografts-for-24-hours
#4
Nicole L Werner, Fares Alghanem, Stephanie L Rakestraw, Dylan C Sarver, Bruce Nicely, Richard E Pietroski, Paul Lange, Steven M Rudich, Christopher L Mendias, Alvaro Rojas-Pena, John C Magee, Robert H Bartlett, Kagan Ozer
BACKGROUND: Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance after procurement. In bilateral hand transplantations, this demands a 2 team approach and expedited transfer of the allograft, limiting the recovery to a small geographic area. Ex situ perfusion may be an alternative allograft preservation method to extend allograft survival time. This is a short report of 5 human limbs maintained for 24 hours with ex situ perfusion. METHODS: Upper limbs were procured from brain-dead organ donors...
March 2017: Transplantation
https://www.readbyqxmd.com/read/28221302/diagnostic-criteria-for-small-fiber-neuropathy
#5
Derrick Blackmore, Zaeem A Siddiqi
OBJECTIVES: Despite its relative common occurrence, definitive diagnosis of small fiber neuropathy (SFN) remains problematic. In practice, patients with pain, numbness, and/or paresthesias in their lower limbs are diagnosed with SFN if found to have dissociated sensory loss in their feet, that is, impaired pinprick perception (PP) but relatively preserved vibration. We sought to assess the sensitivity and specificity of clinical examination and various diagnostic tools available for screening SFN...
March 2017: Journal of Clinical Neuromuscular Disease
https://www.readbyqxmd.com/read/28221245/an-articulating-antibiotic-cement-spacer-for-first-stage-reconstruction-for-infected-total-elbow-arthroplasty
#6
Kanishka E Williams, Simon MacLean, Jesse Jupiter, Gregory I Bain
Management of an infected total elbow replacement is a significant clinical challenge. Although preservation of the prosthesis is ideal, a 2-stage revision is often necessary. Unlike lower limb arthroplasty, antibiotic spacers are not commercially available. Monoblock cement spacers do not allow elbow movements and are therefore associated with severe stiffness and scarring, leading to poor clinical outcomes. In our paper we present a simple and novel technique for constructing an articulating antibiotic-impregnated spacer for use as an implant for a 1-stage revision of an infected elbow arthroplasty...
February 17, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28220751/upper-extremity-sarcoma-impact-of-current-practice-guidelines-and-controversies-on-reconstructive-approaches
#7
Marek Dobke, Gina A Mackert
The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD) orthopedic and plastic surgery team (2011-2016) and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials...
2017: SICOT-J
https://www.readbyqxmd.com/read/28216820/siliconomas-of-the-lower-limb-tumour-like-excision-and-reconstruction
#8
Tommaso Agostini, Raffaella Perello
BACKGROUND: Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications. OBJECTIVES: The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone...
September 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/28202211/the-risk-of-postoperative-complications-and-functional-impairment-after-multimodality-treatment-for-limb-and-trunk-wall-soft-tissue-sarcoma-long-term-results-from-a-monocentric-series
#9
E Stoeckle, A Michot, L Rigal, F Babre, P Sargos, B Henriques de Figueiredo, V Brouste, A Italiano, M Toulmonde, F Le Loarer, M Kind
BACKGROUND AND OBJECTIVES: Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives. METHODS: A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012...
February 3, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28195886/pedicled-sensate-composite-calcaneal-flap-in-children-with-congenital-tibial-pseudoarthrosis
#10
Mauricio L D Mongon, Fernando C Ribera, Antonio M A de Souza, Aurelio L Sposito, William D Belangero, Bruno Livani
BACKGROUND: The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait...
February 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28190718/unilateral-inline-replacement-of-infected-aortofemoral-graft-limb-with-femoral-vein
#11
Christian D Simmons, Ahsan T Ali, Kousta Foteh, Matthew R Abate, Matthew R Smeds, Horace J Spencer, G Patrick Clagett
OBJECTIVE: Aortic graft infection remains a formidable challenge for the vascular surgeon. Traditionally, reconstruction with a neoaortoiliac system (NAIS) involves removal of the entire synthetic graft with in situ reconstruction using femoral vein. Whereas the NAIS procedure is durable with excellent graft patency and a low reinfection rate, it can take up to 10 hours and result in a high perioperative complication rate with significant mortality. Not infrequently, the infection is limited to a single limb...
February 9, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28187791/primary-mediastinal-large-b-cell-lymphoma-in-a-woman-who-is-human-immunodeficiency-virus-positive-presenting-with-superior-vena-cava-syndrome-a-case-report
#12
Pedro Pallangyo, Paulina Nicholaus, Frederick Lyimo, Elikaanany Urio, Peter Kisenge, Mohamed Janabi
BACKGROUND: The risk of non-Hodgkin lymphoma is increased 200-fold in individuals seropositive for human immunodeficiency virus compared to those free from human immunodeficiency virus. Human immunodeficiency virus-associated non-Hodgkin lymphoma is known for its atypical presentation, aggressive ability, widespread involvement, poor response to chemotherapy, and high relapse potential which makes both the diagnosis and management a difficult undertaking especially in resource-poor settings...
February 11, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28171843/gait-kinetics-of-total-hip-replacement-patients-a-large-scale-long-term-follow-up-study
#13
Damien Bennett, Paul Ryan, Seamus O'Brien, David E Beverland
BACKGROUND: It is not known if lower limb gait kinetics of total hip replacement (THR) patients reach normal levels at long term follow-up post-operatively. METHODS: Three-dimensional gait analysis was performed on 134 THR patients with identical implants 10-years post-operatively. Lower limb moments and powers were compared between different age strata (54-64 years, 65-69 years, 70-74 years, 75-79 years and over 80 years) and a normal elderly control group. RESULTS: Hip extensor moment and hip power generation were significantly reduced in all age groups compared to normal...
January 21, 2017: Gait & Posture
https://www.readbyqxmd.com/read/28161012/intraoperative-identification-of-the-negative-motor-network-during-awake-surgery-to-prevent-deficit-following-brain-resection-in-premotor-regions
#14
F Rech, H Duffau, C Pinelli, A Masson, P Roublot, A Billy-Jacques, H Brissart, T Civit
INTRODUCTION: Surgical resection in premotor areas can lead to supplementary motor area syndrome as well as a permanent deficit. However, recent findings suggest a putative role of the negative motor network in those dysfunctions. Our objective was to compare the functional results in two groups of adult patients who underwent the resection of a frontal glioma with and without resection of the negative motor networks. MATERIAL AND METHODS: Twelve patients (total of 13 surgeries) were selected for awake surgery for a frontal glioma...
February 1, 2017: Neuro-Chirurgie
https://www.readbyqxmd.com/read/28159052/complex-ankle-arthrodesis-with-step-cut-osteotomy-in-charcot-arthropathy-with-bone-loss
#15
Sean Booth, Moez Ballal, Anand Pillai
We report a case of a complex limb salvage ankle arthrodesis in a patient with Charcot arthropathy. A step-cut osteotomy was performed in order to tackle the issues of anterior tibial bone loss; worsening leg length discrepancy; soft tissue contraction; joint instability and high risk of non-union. The construct formed by the step-cut allowed for the preservation of good bone stock; avoidance of further limb shortening; increased torsional stability and increased surface area for bony union. This resulted in a patient with a stable, plantigrade foot appropriate for footwear...
March 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28155066/pediatric-musculoskeletal-injuries-role-of-ultrasound-and-magnetic-resonance-imaging
#16
REVIEW
C L Piccolo, M Galluzzo, S Ianniello, M Trinci, A Russo, E Rossi, M Zeccolini, A Laporta, G Guglielmi, V Miele
Pediatric musculoskeletal system is particularly prone to traumatic and sports-related injuries, both acute and chronic, i.e., overuse injuries, because of inherent conditions of weakness, such as the open physis, representing the weakest aspect within the bone, the ligamentous supports and changing biomechanics. Being aware that a quick diagnosis is essential to preserve the good functionality of the limb involved, it is mandatory for the radiologist to recognize the most common patterns of these injuries, identifying those requiring a prompt surgery, as well as be confident with the technique performed, and be supported by an important background experience and knowledge skills...
February 2, 2017: Musculoskeletal Surgery
https://www.readbyqxmd.com/read/28149224/delayed-surgical-debridement-and-use-of-semiocclusive-dressings-for-salvage-of-fingers-after-purpura-fulminans
#17
Paula A Pino, Javier A Román, Felipe Fernández
Background: Purpura fulminans is a condition characterized by rapidly evolving skin necrosis and disseminated intravascular coagulation. Early recognition and aggressive supportive management has led to a decrease in its mortality rate, but most of these patients must undergo extensive soft tissue debridement and partial or total limb amputation. There is controversial evidence about the timing of surgery, suggesting that some patients may benefit from delayed debridement with limb preservation. Methods: We present a case of an 86-year-old patient who developed skin necrosis of his four limbs after infectious purpura fulminans...
December 2016: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28139009/the-twisted-structure-of-the-achilles-tendon-unraveled-a-detailed-quantitative-and-qualitative-anatomical-investigation
#18
P A Pękala, B M Henry, A Ochała, P Kopacz, G Tatoń, A Młyniec, J A Walocha, K A Tomaszewski
The Achilles tendon (AT) consists of fibers originating from the soleus muscle (SOL), which lies deep, and the medial (GM) and lateral (GL) heads of the gastrocnemius muscle, which lie superficial. As the fibers descend toward the insertion of the AT, the individual subtendons twist around each other. The aim of this study was to investigate the twisted structure of the AT and its individual subtendons. Specimens of the AT, with preserved calcaneal bone and a fragment of the triceps surae muscle, were obtained from 53 fresh-frozen, male cadavers (n=106 lower limbs)...
January 30, 2017: Scandinavian Journal of Medicine & Science in Sports
https://www.readbyqxmd.com/read/28138789/phrenic-nerve-palsy-secondary-to-parsonage-turner-syndrome-a-diagnosis-commonly-overlooked
#19
Tom McEnery, Ronan Walsh, Conor Burke, Aisling McGowan, John Faul, Liam Cormican
Neuralgic Amyotrophy (NA) or Parsonage-Turner syndrome is an idiopathic neuropathy commonly affecting the brachial plexus. Associated phrenic nerve involvement, though recognised, is thought to be very rare. We present a case series of four patients (all male, mean age 53) presenting with dyspnoea preceded by severe self-limiting upper limb and shoulder pain, with an elevated hemi-diaphragm on clinical examination and chest X-ray. Neurological examination of the upper limb at the time of presentation was normal...
January 30, 2017: Lung
https://www.readbyqxmd.com/read/28133577/neck-biomechanics-indicate-that-giant-transylvanian-azhdarchid-pterosaurs-were-short-necked-arch-predators
#20
Darren Naish, Mark P Witton
Azhdarchid pterosaurs include the largest animals to ever take to the skies with some species exceeding 10 metres in wingspan and 220 kg in mass. Associated skeletons show that azhdarchids were long-necked, long-jawed predators that combined a wing planform suited for soaring with limb adaptations indicative of quadrupedal terrestrial foraging. The postcranial proportions of the group have been regarded as uniform overall, irrespective of their overall size, notwithstanding suggestions that minor variation may have been present...
2017: PeerJ
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