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  1 / 16916 MEDLINE  
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[PMID]:29414988
[Au] Autor:Morgan SJ; McDonald CL; Halsne EG; Cheever SM; Salem R; Kramer PA; Hafner BJ
[Ad] Endereço:Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States of America.
[Ti] Título:Laboratory- and community-based health outcomes in people with transtibial amputation using crossover and energy-storing prosthetic feet: A randomized crossover trial.
[So] Source:PLoS One;13(2):e0189652, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Contemporary prosthetic feet are generally optimized for either daily or high-level activities. Prosthesis users, therefore, often require multiple prostheses to participate in activities that span a range of mobility. Crossover feet (XF) are designed to increase the range of activities that can be performed with a single prosthesis. However, little evidence exists to guide clinical prescription of XF relative to traditional energy storing feet (ESF). The objective of this study was to assess the effects of XF and ESF on health outcomes in people with transtibial amputation. A randomized crossover study was conducted to assess changes in laboratory-based (endurance, perceived exertion, walking performance) and community-based (step activity and self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction) outcomes. Twenty-seven participants were fit with XF and ESF prostheses with standardized sockets, interfaces, and suspensions. Participants were not blinded to the intervention, and wore each prosthesis for one month while their steps were counted with an activity monitor. After each accommodation period, participants returned for data collection. Endurance and perceived exertion were measured with the Six-Minute Walk Test and Borg-CR100, respectively. Walking performance was measured using an electronic walkway. Self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction were measured with survey instruments. Participants also reported foot preferences upon conclusion of the study. Differences between feet were assessed with a crossover analysis. While using XF, users experienced improvements in most community-based outcomes, including mobility (p = .001), fatigue (p = .001), balance confidence (p = .005), activity restrictions (p = .002), and functional satisfaction (p < .001). Participants also exhibited longer sound side steps in XF compared to ESF (p < .001). Most participants (89%) reported an overall preference for XF; others (11%) reported no preference. Results indicate that XF may be a promising alternative to ESF for people with transtibial amputation who engage in a range of mobility activities. TRIAL REGISTRATION: ClinicalTrials.gov NCT02440711.
[Mh] Termos MeSH primário: Amputação
Membros Artificiais

Próteses e Implantes
Tíbia/cirurgia
[Mh] Termos MeSH secundário: Estudos Cross-Over
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180208
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189652


  2 / 16916 MEDLINE  
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[PMID]:28470463
[Au] Autor:Hoffmeister T; Schwarze F; Aschoff HH
[Ad] Endereço:Sana Kliniken Lübeck GmbH, Kronsforder Allee 71/73, 23560, Lübeck, Deutschland.
[Ti] Título:[The endo-exo prosthesis treatment concept : Improvement in quality of life after limb amputation].
[Ti] Título:Das Endo-Exo-Prothesen-Versorgungskonzept : Verbesserung der Lebensqualität nach Extremitätenamputation..
[So] Source:Unfallchirurg;120(5):371-377, 2017 May.
[Is] ISSN:1433-044X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Osseointegrated, percutaneous implants as the force bearer for exoprosthetics after limb amputation have been used in individual cases for clinical rehabilitation of amputees during the past years. Most experience in this field in Germany has been accumulated at the Sana Klinik in Lübeck with the so-called endo-exo prosthesis (EEP) system. The two-step implantation procedure can now be considered as reliable. Following a well-documented learning curve initial soft tissue problems concerning the cutaneous stoma can now be regarded as exceptions. The retrospective examination of the results concerning by now more than 100 patients provided with an endo-exo femoral prosthesis (EEFP) showed a very satisfying outcome concerning objective as well as subjective values, such as duration of daily use and wearing comfort of the exoprosthesis. Regaining the ability of osseoperception due to the intraosseous fixation is described by the patients as a great advantage. The step from a socket prosthesis to an EEP is felt to be a big increase in quality of life by nearly all patients included into the follow-up. Nearly all of the patients questioned would choose an endo-exo prosthesis again. Meanwhile, the success of the EEP resulted in the broadening of indications from above-knee amputations to transtibial as well as transhumeral amputations. The results are likewise encouraging. The use of EEP for the upper limbs leads to substantial improvement in the range of motion of the shoulder joint with the intramedullary anchored percutaneous implant. Furthermore, new pathbreaking possibilities in the fixation of myoelectrically controlled arm prostheses may arise from the EEP technique.
[Mh] Termos MeSH primário: Cotos de Amputação/cirurgia
Amputação/reabilitação
Artroplastia de Quadril/instrumentação
Exoesqueleto Energizado
Prótese de Quadril
Perna (Membro)/cirurgia
Qualidade de Vida/psicologia
[Mh] Termos MeSH secundário: Amputação/psicologia
Artroplastia de Quadril/métodos
Artroplastia de Quadril/psicologia
Membros Artificiais
Terapia Combinada/instrumentação
Terapia Combinada/métodos
Terapia Combinada/psicologia
Seres Humanos
Osseointegração
Desenho de Prótese
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1007/s00113-017-0350-1


  3 / 16916 MEDLINE  
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[PMID]:28470462
[Au] Autor:Grundei H; Timmermann A
[Ad] Endereço:Fa. Eska Orthopaedic Handels GmbH, Osterweide 2c, 23562, Lübeck, Deutschland. info@eskaorthopaedic.de.
[Ti] Título:[Connecting adapter for coupling exoprostheses to endoshafts : Demands on orthopedic technicians with respect to planning and application].
[Ti] Título:Anschlussadapter zur Ankopplung der Exoprothese an den Endostiel : Anforderungen an den Orthopädietechniker hinsichtlich Planung und Anwendung..
[So] Source:Unfallchirurg;120(5):378-384, 2017 May.
[Is] ISSN:1433-044X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:INTRODUCTION: Transcutaneous, bone anchored prostheses have proved to be an alternative for amputees. In addition to the safe osseointegration of the implant, the correct prosthetic alignment is also important. Therefore, the interaction between prosthesis components and the prosthesis wearer is significant and the role of the certified prosthetist should not be underestimated. AIM: The aim of treatment is the best possible compensation of disability after limb loss with increase of physical abilities and comfort of the prosthesis wearer by means of bone anchored prosthesis. METHOD: Endoprosthesis inserted by the surgeon carrying out both surgery with the implant and a double-cone and 6 weeks later the exoprosthesis is fitted by the certified prosthetist orthotist (CPO). Mounting the external adaptors, assembly of the prosthesis. RESULTS: The long-term results with cementless implants and more than 35 years experience are presented. Clinical experience with the endo-exo prosthesis since 1999. A total of 135 patients treated after transfemoral amputation, 8 of them bilateral, 8 out of 135 were transtibial amputees and 1 of them bilateral. A total of 85% were amputated as a consequence of trauma and 12 out of 135 had a full range of motion at the beginning of the prosthetic work following osseointegration. In other cases, a hip flexion contracture between 3 and 12 ° had to be considered by corresponding posterior displacement adaptors. CONCLUSION: Bone anchored prostheses influence the skeleton and joints in a more direct way. This fact requires specific prosthetic measures concerning the connection between the endo-implant and the exoprosthesis. Therefore, specially matched adaptors and the prosthetic alignment are the focus of interest. Prostheses connected to an osseointegrated implant have many biomechanical advantages compared to socket-guided prostheses. Because the quality of rehabilitation is clearly affected by the prosthetic alignment, it has to be carried out extremely carefully and precisely if the prosthesis is connected to an osseointegrated implant. According to the survey, none of the prosthesis wearers wanted to return to a socket-guided prosthesis.
[Mh] Termos MeSH primário: Cotos de Amputação/cirurgia
Amputação/reabilitação
Artroplastia de Substituição/instrumentação
Membros Artificiais
Exoesqueleto Energizado
Prótese Articular
Perna (Membro)/cirurgia
[Mh] Termos MeSH secundário: Artroplastia de Substituição/métodos
Terapia Combinada/instrumentação
Terapia Combinada/métodos
Seres Humanos
Osseointegração
Desenho de Prótese
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1007/s00113-017-0351-0


  4 / 16916 MEDLINE  
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[PMID]:29169593
[Au] Autor:Tosti R; Eberlin KR
[Ad] Endereço:Department of Orthopedic Surgery, The Philadelphia Hand Center, Sidney Kimmel Medical College, Thomas Jefferson University, 834 Chestnut Street Suite G114, Philadelphia, PA 19107, USA.
[Ti] Título:"Damage Control" Hand Surgery: Evaluation and Emergency Management of the Mangled Hand.
[So] Source:Hand Clin;34(1):17-26, 2018 02.
[Is] ISSN:1558-1969
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mangled hand injuries are defined as those with significant damage to multiple structures, which may be limb threatening. Historically these injuries resulted in amputation or death, but modern surgical and perioperative advances allow for complex reconstruction and the possibility of a sensate and functional limb. Evaluation begins with surveying for life-threatening injuries followed by a systematic approach to identify injured structures; management begins with preserving all parts, minimizing warm ischemia time, performing débridement, and planning an operative approach to optimize the chance of a functional limb. With careful surgical planning and a well-executed reconstruction, most limbs can be salvaged.
[Mh] Termos MeSH primário: Traumatismos da Mão/cirurgia
[Mh] Termos MeSH secundário: Amputação
Antibacterianos/uso terapêutico
Medicina de Emergência
Seres Humanos
Traumatismos dos Nervos Periféricos/cirurgia
Cuidados Pós-Operatórios
Reimplante
Terapia de Salvação
Retalhos Cirúrgicos
Traumatismos dos Tendões/cirurgia
Lesões do Sistema Vascular/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180303
[Lr] Data última revisão:
180303
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171125
[St] Status:MEDLINE


  5 / 16916 MEDLINE  
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[PMID]:29318581
[Au] Autor:Vietto V; Franco JV; Saenz V; Cytryn D; Chas J; Ciapponi A
[Ad] Endereço:Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
[Ti] Título:Prostanoids for critical limb ischaemia.
[So] Source:Cochrane Database Syst Rev;1:CD006544, 2018 01 10.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity and mortality due to cardiovascular disease in the general population. Although numerous treatments have been adopted for patients at different disease stages, no option other than amputation is available for patients presenting with critical limb ischaemia (CLI) unsuitable for rescue or reconstructive intervention. In this regard, prostanoids have been proposed as a therapeutic alternative, with the aim of increasing blood supply to the limb with occluded arteries through their vasodilatory, antithrombotic, and anti-inflammatory effects. This is an update of a review first published in 2010. OBJECTIVES: To determine the effectiveness and safety of prostanoids in patients with CLI unsuitable for rescue or reconstructive intervention. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (January 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1). In addition, we searched trials registries (January 2017) and contacted pharmaceutical manufacturers, in our efforts to identify unpublished data and ongoing trials. SELECTION CRITERIA: Randomised controlled trials describing the efficacy and safety of prostanoids compared with placebo or other pharmacological control treatments for patients presenting with CLI without chance of rescue or reconstructive intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. We resolved disagreements by consensus or by consultation with a third review author. MAIN RESULTS: For this update, 15 additional studies fulfilled selection criteria. We included in this review 33 randomised controlled trials with 4477 participants; 21 compared different prostanoids versus placebo, seven compared prostanoids versus other agents, and five conducted head-to-head comparisons using two different prostanoids.We found low-quality evidence that suggests no clear difference in the incidence of cardiovascular mortality between patients receiving prostanoids and those given placebo (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.41 to 1.58). We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared with placebo (RR 0.97, 95% CI 0.86 to 1.09). Adverse events were more frequent with prostanoids than with placebo (RR 2.11, 95% CI 1.79 to 2.50; moderate-quality evidence). The most commonly reported adverse events were headache, nausea, vomiting, diarrhoea, flushing, and hypotension. We found moderate-quality evidence showing that prostanoids reduced rest-pain (RR 1.30, 95% CI 1.06 to 1.59) and promoted ulcer healing (RR 1.24, 95% CI 1.04 to 1.48) when compared with placebo, although these small beneficial effects were diluted when we performed a sensitivity analysis that excluded studies at high risk of bias. Additionally, we found evidence of low to very low quality suggesting the effects of prostanoids versus other active agents or versus other prostanoids because studies conducting these comparisons were few and we judged them to be at high risk of bias. None of the included studies assessed quality of life. AUTHORS' CONCLUSIONS: We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared against placebo. Moderate-quality evidence showed small beneficial effects of prostanoids for rest-pain relief and ulcer healing when compared with placebo. Additionally, moderate-quality evidence showed a greater incidence of adverse effects with the use of prostanoids, and low-quality evidence suggests that prostanoids have no effect on cardiovascular mortality when compared with placebo. None of the included studies reported quality of life measurements. The balance between benefits and harms associated with use of prostanoids in patients with critical limb ischaemia with no chance of reconstructive intervention is uncertain; therefore careful assessment of therapeutic alternatives should be considered. Main reasons for downgrading the quality of evidence were high risk of attrition bias and imprecision of effect estimates.
[Mh] Termos MeSH primário: Isquemia/tratamento farmacológico
Perna (Membro)/irrigação sanguínea
Doenças Vasculares Periféricas/tratamento farmacológico
Prostaglandinas/uso terapêutico
[Mh] Termos MeSH secundário: Alprostadil/uso terapêutico
Amputação/estatística & dados numéricos
Epoprostenol/uso terapêutico
Seres Humanos
Iloprosta/uso terapêutico
Isquemia/mortalidade
Perna (Membro)/cirurgia
Úlcera da Perna/tratamento farmacológico
Nafronil/uso terapêutico
Ácidos Nicotínicos/uso terapêutico
Pentoxifilina/uso terapêutico
Prostaglandinas/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Vasodilatadores/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Nicotinic Acids); 0 (Prostaglandins); 0 (Vasodilator Agents); 42H8PQ0NMJ (Nafronyl); A99MK953KZ (Inositol Niacinate); DCR9Z582X0 (Epoprostenol); F5TD010360 (Alprostadil); JED5K35YGL (Iloprost); SD6QCT3TSU (Pentoxifylline)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006544.pub3


  6 / 16916 MEDLINE  
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[PMID]:29237360
[Au] Autor:Modaghegh MS; Hafezi S
[Ad] Endereço:1 Vascular and Endovascular Surgery Research Center, Alavi Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
[Ti] Título:Endovascular Treatment of Thromboangiitis Obliterans (Buerger's Disease).
[So] Source:Vasc Endovascular Surg;52(2):124-130, 2018 Feb.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: When critical limb ischemia (CLI) occurs in patients with thromboangiitis obliterans (TAO) or Buerger's disease, smoking cessation alone may be insufficient to relieve rest pain and promote wound healing. Accordingly, adjunctive measures are warranted to restore adequate blood flow required for limb salvage. This study aimed to evaluate the feasibility and efficacy of percutaneous transluminal angioplasty (PTA) for the treatment of patients with TAO and CLI. In addition, a review of the literature on endovascular management of TAO is included. METHODS: Between April 2012 and June 2017, all patients with TAO and CLI who underwent PTA were studied retrospectively. Patient demographics, presentation, procedural details, and clinical response were recorded. Patients were monitored at 1 week, 1, 2, 3, and 6 months after revascularization and at least every 6 months thereafter. RESULTS: Thirteen patients with TAO and CLI, who presented with rest pain only (n = 1), ischemic ulcer (n = 4), or gangrene (n = 8) underwent endovascular interventions with primary and assisted primary technical success of 85% and 92%, respectively. A below-knee amputation was eventually done in the only patient with technical failure (limb salvage rate: 92%). Following the procedures, 11 patients had clinical response, one of whom also received intra-arterial vasodilator to achieve complete symptom relief. The other patient who failed PTA underwent a successful lumbar sympathectomy. In addition, all ulcers healed and eight minor amputations were performed due to already established gangrene. During follow-up (mean: 19.4 months), four patients needed reintervention. Patients who continued to smoke experienced more severe ischemia ( P = .017) and were more likely to require reintervention ( P = .009). CONCLUSION: Percutaneous transluminal angioplasty can be considered as a technically feasible and potentially effective treatment for patients with TAO and CLI, as well as a last resort for limb salvage when other options have failed. However, reintervention may be required, especially in patients who continue smoking.
[Mh] Termos MeSH primário: Angioplastia com Balão
Tromboangiite Obliterante/terapia
[Mh] Termos MeSH secundário: Adulto
Amputação
Angioplastia com Balão/efeitos adversos
Intervalo Livre de Doença
Estudos de Viabilidade
Feminino
Seres Humanos
Salvamento de Membro
Masculino
Meia-Idade
Retratamento
Estudos Retrospectivos
Fatores de Risco
Fumar/efeitos adversos
Tromboangiite Obliterante/diagnóstico por imagem
Tromboangiite Obliterante/etiologia
Tromboangiite Obliterante/fisiopatologia
Fatores de Tempo
Resultado do Tratamento
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417744085


  7 / 16916 MEDLINE  
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[PMID]:29202650
[Au] Autor:Wrede A; Wiberg F; Acosta S
[Ad] Endereço:These authors contributed equally to this work.
[Ti] Título:Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm.
[So] Source:Vasc Endovascular Surg;52(2):115-123, 2018 Feb.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Open repair (OR) for popliteal artery aneurysm (PAA) has recently been challenged by endovascular repair (ER) as the primary choice of treatment. The aim of the present study was to evaluate time trends in treatment modality and compare outcomes between OR and ER among electively operated patients after start of screening in 2010 for abdominal aortic aneurysm (AAA), a disease highly associated with PAA. METHODS: Between January 1, 2009, and April 30, 2017, 102 procedures and 36 acute and 66 elective repairs for PAA were identified. RESULTS: Over time, a trend ( P = .089) for an increasing elective to acute repair ratio of PAA and an increase in elective ER to OR ratio ( P = .003) was found. Among electively repaired PAAs, the ER group was older ( P = .047) and had a higher ankle-brachial index (ABI; P = .044). The ER group had fewer wound infections ( P = .003), fewer major bleeding complications ( P = .046), and shorter in-hospital stay ( P < .001). After 1 year of follow-up, the ER group had a higher rate of major amputations ( P = .037). Amputation-free survival at the end of follow-up did not differ between groups ( P = .68). Among the 17 patients with PAA eligible for AAA screening, 4 (24%) were diagnosed with PAA through the screening program of AAA. CONCLUSION: The epidemiology of elective repair of PAA has changed toward increased ER, although ER showed a higher rate of major amputations at 1 year. Confounding was considerable and a randomized trial is needed for evaluation of the best therapeutic option.
[Mh] Termos MeSH primário: Aneurisma/cirurgia
Implante de Prótese Vascular
Procedimentos Endovasculares
Artéria Poplítea/cirurgia
Veia Safena/transplante
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Amputação
Aneurisma/diagnóstico por imagem
Aneurisma/epidemiologia
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/tendências
Procedimentos Cirúrgicos Eletivos
Procedimentos Endovasculares/efeitos adversos
Procedimentos Endovasculares/tendências
Feminino
Seres Humanos
Salvamento de Membro
Masculino
Meia-Idade
Artéria Poplítea/diagnóstico por imagem
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Fatores de Risco
Suécia/epidemiologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417742762


  8 / 16916 MEDLINE  
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[PMID]:28463345
[Au] Autor:Upadhyaya MA; Nasrallah HA
[Ad] Endereço:The Everest Foundation, Los Angeles, CA USA E-mail: mupadhya@bronxleb.org
[Ti] Título:The intense desire for healthy limb amputation: A dis-proprioceptive neuropsychiatric disorder.
[So] Source:Ann Clin Psychiatry;29(2):125-132, 2017 05.
[Is] ISSN:1547-3325
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The first mention of a condition in which apparently nonpsychotic individuals have a strong, unrelenting desire to amputate ≥1 of their healthy limbs was published nearly 4 decades ago. Once dismissed as a paraphilia, the condition in recent years has been re-investigated with neurologic testing and imaging, yielding evidence suggesting it may be attributable to a neuroanatomical anomaly. METHODS: A literature review of data was conducted of recently published studies with pinprick testing, magnetic resonance imaging (MRI)/functional MRI imaging, magnetoencephalography, and interviews of individuals with a desire for limb amputation. RESULTS: Published literature on this condition features studies with a limited number of participants. However, the results indicate that affected individuals predominantly desire amputation of the left lower limb, and correspondingly, usually have changes in cortical thickness in the right parietal lobe. CONCLUSIONS: Further investigation of this condition is warranted, particularly, more research into the precise nature of the anomalous neuroanatomy, biopsychosocial background of those with the condition, and longitudinal perspective of the childhood onset and evolution of symptoms. Large sample studies involving a collaborative effort across multiple sites are required.
[Mh] Termos MeSH primário: Amputação/psicologia
Transtornos Dismórficos Corporais
Técnicas de Rastreamento Neuroanatômico/métodos
Distúrbios Somatossensoriais
[Mh] Termos MeSH secundário: Transtornos Dismórficos Corporais/patologia
Transtornos Dismórficos Corporais/psicologia
Lateralidade Funcional
Seres Humanos
Imagem por Ressonância Magnética/métodos
Testes Neuropsicológicos
Distúrbios Somatossensoriais/patologia
Distúrbios Somatossensoriais/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


  9 / 16916 MEDLINE  
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[PMID]:29179049
[Au] Autor:Michael AR
[Ad] Endereço:Idaho State University, Department of Anthropology, 921S. 8th Avenue, Stop 8005, Pocatello, ID 83209, USA. Electronic address: michamy@isu.edu.
[Ti] Título:Histological estimation of age at death in amputated lower limbs: Issues of disuse, advanced age, and disease in the analysis of pathological bone.
[So] Source:J Forensic Leg Med;53:58-61, 2018 Jan.
[Is] ISSN:1878-7487
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Histological studies of healed bone tissue following amputation are relatively rare in the literature. This study describes the histomorphological features of femoral thin sections from six uni- and bi-lateral amputees of documented age and sex. Thin sections were cut from the midshaft of both the right and left femora from each amputee and analyzed following standard forensic methods for histological estimation of age at death from the human femur. The histological age at death estimations for the thin sections from amputated bone were consistently lower than the actual chronological age of each individual, suggesting that the effects of amputation prohibit the effective use of age at death estimation methods. The nature of each amputation is unknown, which suggests that alternative factors could be responsible for the slowed bone turnover seen in the thin sections from the amputated bone. First, it is reasonable to assume that the amputations in this sample could have resulted from complications of diabetes mellitus rather than trauma so the possible effects on bone remodeling due to disease are explored. Second, the mobility of the decedents following their amputations is unknown so the histomorphological results could be due to disuse osteoporosis.
[Mh] Termos MeSH primário: Amputação
Amputados
Fêmur/patologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Reabsorção Óssea
Osso Cortical/patologia
Feminino
Patologia Legal
Osteon/patologia
Seres Humanos
Masculino
Porosidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29384879
[Au] Autor:Jung KJ; Nho JH; Cho HK; Hong S; Won SH; Chun DI; Kim B
[Ad] Endereço:Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan-si.
[Ti] Título:Amputation of multiple limbs caused by use of inotropics: Case report, a report of 4 cases.
[So] Source:Medicine (Baltimore);97(5):e9800, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: We present 4 cases of symmetrical peripheral gangrene (SPG) associated with use of inotropic agent to elevate blood pressure. SPG is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of 2 or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather than thrombosis is implicated as the underlying pathophysiology. We present 4 SPG cases of the multiple limbs amputation, associated with inevitable use of inotropic agents. PATIENT CONCERNS: Inotropic agents including dopamine and norepinephrine are used frequently in the treatment of hypotension, and its effectiveness in treating shock is firmly established. However, it can be caused peripheral gangrene by prolonged administration of high dose inotropics, inducing the constant contraction of the peripheral blood vessels. DIAGNOSIS: These 4 patients had different clinical histories and background factors, but each experienced sepsis. The level of amputation is determined by the line of demarcation in concert with considerations of the biomechanics of stump stability, weight bearing, and ambulation. INTERVENTIONS: After recovering of general conditions and completion of demarcation, these 4 patients underwent the amputation of multiple limbs.(bilateral amputations of upper extremities or bilateral amputations of lower extremities). OUTCOMES: In each patient, there was no additional amputation caused by extension of SPG, and the rehabilitation with appropriate orthosis was performed. Treatment of underlying disease were continued too. LESSONS: It is important to alert the possibility of amputations, according to the use of inevitable inotropics. We recommended the careful use of the inotropic agents to the physicians in treating septic shock.
[Mh] Termos MeSH primário: Amputação
Cardiotônicos/efeitos adversos
Dopamina/efeitos adversos
Extremidades/irrigação sanguínea
Extremidades/patologia
Norepinefrina/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Extremidades/cirurgia
Feminino
Gangrena
Seres Humanos
Masculino
Meia-Idade
Vasoconstritores/efeitos adversos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cardiotonic Agents); 0 (Vasoconstrictor Agents); VTD58H1Z2X (Dopamine); X4W3ENH1CV (Norepinephrine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009800



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