Rehabilitation program for children and adolescents with limb defects or amputations of the lower extremity

In rehabilitation of children and adolescents with lower limb deficiencies it is very important that the medical team taking care of the patient works out a treatment plan. Responsible cooperation with the parents is of utmost importance, the focus of all efforts is, of course, the handicapped child. The aims of rehabilitation are illustrated by examples demonstrating the course of successful rehabilitation of children and adolescents with damaged limbs. Equally, the psychological situation of the parents and child is taken into consideration. Children with limb deficiencies or amputation of the lower extremities should be enabled to stand and walk according to their state of development, because standing and walking in particular are among the most important preconditions for the best possible integration. Provision with a prosthesis, orthosis and orthoprosthesis is therefore indispensable for rehabilitation. While a prosthesis replaces parts of an extremity, an orthosis stabilizes the existing extremity. Orthoprostheses compensate longitudinal malformations, have a supporting effect, allow growth to be controlled, and compensate for shortening. Just as important as these technical aids is early medical treatment. The sooner the treatment starts, the better the results.     

Vitamin E and A deficiencies in children correlate with Chernobyl radiation loads of their mothers

Essential lipid bioantioxidants (BAO) (vitamins E and A) and catabolic products of the lipoperoxide cascade (LPC) (diene conjugates, ketodienes, and carbonyls) were determined in blood plasma of children aged 11 days to three years (n = 123) who are residents of regions contaminated with radionuclides (5-40 Ci/km2 of 137Cs) discharged during the Chernobyl power plant accident. Individual antenatal radiation loads Da of children and total radiation doses of their mothers Dm were also determined as external gamma-radiation loads, which correlate with internal radiation doses for permanent residents of contaminated regions. Before examination, therapy with multivitamins containing BAO determined in this work was administered to groups of pregnant women and their children (group I, n = 48) age-matched to a group that received no therapy (group II, n = 99). In group II, reduced concentrations of vitamins E and A decreased to levels indicating severe vitamin deficiency and displayed inverse correlations with Dm and Da. However, in group I these decreases and inverse correlation were only characteristic of initially normal levels of tocopherol. In group II, increases in Dm and Da caused stress-related increases in blood levels of diene conjugates and ketodienes (which was stronger than in group I with increases in Da) and, because of this, E and A vitamin deficiencies. In group I, LPC levels inversely correlated with Dm. We found nine significant correlations of radioloads of mothers with BAO and LPC pathologies of their children. The total pathogenic effectiveness of Dm in relation to LPC and BAO of children is comparable to the effectiveness of Da, which is the most hazardous radiation load. The possibility of existence of a radiation-induced protective response mobilizing BAO from depots into the blood stream is considered. BAO therapy increased the radiation resistance of children. A hypothesis was formulated that the uptake by children of their mother's radioactive Chernobyl isotopes in amounts adequate to their radiation loads is the mechanism of correlations of Dm with long-term pathogenic effects on BAO and LPC systems of children.     

The liberal ophthalmologists of the northern France and management of children with vision deficiencies

PURPOSE: The purpose of this analysis was to appreciate the management of visually handicaped children outside specialized structures. We also assessed relays between primary physicians, hospitals and specialized structures. METHOD: A 12-question survey was sent to 144 liberal ophthalmologists of the North of France. The questionnary included 12 questions. We compared the results to litterature. RESULTS: The response-rate was 59.6%. This study indicated that the observed children by the liberal ophtalmologists had more simple diseases than in specialized structures. In hospitals, it seemed that the ophtalmologists diagnosed more severe diseases. These practitioners diagnosed some of these diseases. However some of diagnosis were to late. This study showed that specialized structures were not enough known by the practitioners who detected this handicap and that the families prefered the taking in charge near their home. CONCLUSION: We demonstrated the necessary organisation of precocious and systematic detection, and the necessary information to all practitioners on specialized structures.     

Processing deficiencies of learning-disabled children who perform poorly on the digit span test.

Conducted 8 experiments to determine which of several theoretically relevant variables (attention, motivation, mnemonic strategies, and subprocessing skills) could account for the poor performance of some learning-disabled children on tests of short-term auditory memory such as the Digit Span subtest of the Revised WISC. Ss were 8 learning-disabled children who performed in the retarded range on the Digit Span subtest, 8 learning-disabled children who performed normally on the test, and 8 average children from the regular classroom. Although there appeared to be subtle differences among Ss in the use of certain consciously applied mnemonic strategies, the major proportion of the recall differences among groups appeared to be due to the inability of one group of learning-disabled children to establish efficient mnemonic codes for highly familiar stimuli. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for above-knee amputations in diabetes mellitus

BACKGROUND: Above-knee amputation (AKA) is a common complication in diabetics, mostly after one or more lower level amputations (LEAs) have been done. The aim of this study was to identify risk factors for AKAs among diabetics. METHODS: We abstracted 1,800 medical records of hospitalizations for LEA. Kaplan's comorbidity classification was used to rank disease severity. We used both univariate and multivariate models to identify risk factors for AKA. RESULTS: Of the 1,043 diabetic amputees in this study, 22% had AKA. Variables associated with AKA were locomotor impairment, severe anemia, history of lower extremity bypass surgery, body mass index (BMI) < 20 kg/m2, female sex, cerebrovascular disease, cardiovascular disease, and SGOT > 40 U/L. CONCLUSIONS: Most of these risk factors represent end-stage processes and do not have good treatment alternatives. Perhaps one of the practical applications of these data is not to describe risk of proximal amputations but instead to look more closely at candidates who should be considered for distal procedures.     

The natural history of great toe amputations

The purpose of this study is to report the prevalence of reamputation following resection of the great toe and first ray in adults with diabetes. We abstracted the medical records of 90 diabetic great-toe and first-ray amputees admitted between 1981 and 1991. The most common etiologies of initial amputations were ulcer with soft tissue infection (39%), ulcer with osteomyelitis (32%), and puncture wounds (12%). Sixty percent of all patients had a second amputation, 21% had a third, and 7% had a fourth. Fifteen percent of the patients who had a second amputation had it contralaterally. Seventeen percent subsequently underwent a below-knee amputation and 11% had a Transmetatarsal amputation on the same extremity, 3% had a below-knee amputation, and 2% a transmetatarsal amputation contralaterally. The mean time from the first to the second amputation was approximately 10 months. The results of this study suggest that a large proportion of patients undergoing an amputation at the level of the great toe or first ray have subsequent amputations in the first year following the initial procedure. Additionally, it appears that the contralateral foot may be at significant risk for distal amputation following resection of the hallux or first day.     

Selenium and iodine deficiencies and selenoprotein function

The present study was designed to evaluate the roles of 5-HT2 and 5-HT3 receptors in the mouse forced swimming test, by using selective agonists and antagonists of 5-HT(2A/C) and 5-HT3 receptor sites. Agonists/antagonists and antidepressants were administered 45 min and 30 min, respectively, prior to testing. Pretreatment with (+/-)-2,5-dimethoxy-4-iodoamphetamine (DOI) (4 mg/kg, i.p.) or 2-methyl-5-HT (4 mg/kg, i.p.) had no effect on the anti-immobility effects of any antidepressant tested. Prior administration of ritanserin (4 mg/kg, i.p.) or ketanserin (8 mg/kg, i.p.), on the other hand, potentiated the effects of sub-active doses of imipramine (8 mg/kg, i.p.) and desipramine (16 mg/kg, i.p.) but not of maprotiline (8 mg/kg, i.p.), fluoxetine (16 mg/kg, i.p.), citalopram (16 mg/kg, i.p.) or fluvoxamine (8 mg/kg, i.p.). Pretreatment with ondansetron (1 X 10(-5) mg/kg, i.p.) enhanced the antidepressant-like effects of sub-active doses of the selective serotonin reuptake inhibitors. The results of the present study suggested that, in the forced swimming test, the selective serotonin reuptake inhibitors act partially through 5-HT3 receptor sites, whereas the tricyclic antidepressants exert effects at 5-HT(2A/C) receptor sites. Anti-immobility effects of the selective noradrenaline reuptake inhibitor, maprotiline, do not seem to be mediated by 5-HT(2A/C) or 5-HT3 receptor function.     

Elective memory deficiencies and restricted cortical lesions

60 subjects with restricted cortical lesions, 7 with diffuse cortical disease, 7 with bilateral lesions of the hippocampo-mamillo-thalamic circuit and 36 normal subjects underwent immediate reproduction tests and training tests in the following three categories: audio-verbal, visuo-spatial, gestural. Subjects with lesions of the H.M.T. circuit had normal results in the three immediate reproduction tests and failed in the three training tests. Subjects with diffuse cortical lesions showed pathological results in all the tests. Subjects with restricted cortical lesions showed selective deficiencies in certain tests; there was no systematic connection between failure in the immediate reproduction test and failure in the corresponding training test. The results were analysed having regard to the location of the lesion but also to the symptoms.     

The diagnosis and treatment of abduction deficiencies

Deficient abduction can be due to both innervational deficiencies and/or mechanical restrictions. Innervational deficiencies include lateral rectus weakness or paralysis, myasthenia gravis, progressive external ophthalmoplegia nd Duane's syndrome with aberrant innervation to the lateral rectus muscle. Mechanical causes include restrictions on the medial side of the globe (a tight medical rectus due to endocrine ophthalmopathy, a contractured medial rectus muscle as a result of a lateral rectus paralysis, excessive resection of the medial rectus muscle, scarring and hemorrhage due to multiple previous operations upon the medial rectus), as well as a posteriorly inserted lateral rectus. This latter condition may result from a traumatically disinserted lateral rectus muscle, an excessively recessed lateral rectus muscle or a lateral rectus that has slipped from its attachment following strabismus surgery. Insufficient force for full abduction is caused by posterior insertion of the lateral rectus. The diagnosis of these various conditions is considered with reference to the forced duction, force generation and saccadic velocity tests. The treatment of these different causes of abduction deficiency is discussed noting that the approach to treatment depends upon the etiology of the abduction deficiency.     

Prevalence and risk factors for diabetes and diabetes-related amputations in American Indians in southern Arizona

OBJECTIVE: To describe the prevalence of NIDDM and LEA using data from a computer-based patient data base. RESEARCH DESIGN AND METHODS: Diabetic patients with and without LEA, and nondiabetic patients were identified by computer search. Charts of diabetic patients were reviewed for confirmation of diagnosis of diabetes and diabetes-related amputation. The diabetic and nondiabetic populations were described, and certain risk factors were identified. RESULTS: The overall prevalence of NIDDM in this tribe in 1985-1986 was 18.3/100 adults (> or = 18 yr of age), whereas the prevalence of LEA/100 adults with NIDDM was 10.3%. Females were 1.3 times as likely to have diagnosed diabetes as males (95% CI 1.2-1.4), and males with diabetes were 1.4 times more likely to have had LEA than females with diabetes (95% CI 1.1-1.9). CONCLUSIONS: Automated health-care delivery data base used for this tribe can be used to maintain surveillance for diabetes and amputations in diabetic patients. Effective programs to prevent complications of diabetes, such as LEA, in this tribe are urgently needed.     

Partial complement deficiencies in idiopathic thrombocytopenia of childhood

We have examined the classical complement activation pathway in 36 children with idiopathic thrombocytopenia (ITP) in a retrospective study. An increased prevalence of congenital, partial complement deficiencies is found in ITP. Homozygous C4A deficiency was found in 5 patients (p < 0.05) and heterozygous C2 deficiency in 2 other patients (p = 0.05). We suggest that some cases of childhood ITP belong to the immune complex mediated diseases, such as systemic lupus erythematosus and that abnormal immune complex formation and clearance may lead to ITP.     

Single dose medication vial packaging deficiencies

OBJECTIVES: Technical success and early outcome of modified surgical techniques integrating interventional procedures for iliac recanalisation performed through an incision in the groin. MATERIALS: Sixty-one consecutive iliac arteries in 59 patients with long occlusions in 16, occlusions of the common iliac in 11, occlusions of the external iliac in 24 and multiple stenoses of the iliac in 10 cases underwent semiclosed recanalisation through a groin incision. METHODS: Passage of the lesion by guidewire permits retrograde ring-stripper endarterectomy over the wire as a guiding splint or thrombectomy with a double lumen balloon catheter. Residual lesions are corrected by balloon or stent angioplasty. Adequate outflow is established by femoral patch plasty. RESULTS: Conversion to a standard operation was required in 10 limbs (failure to recanalise the lesion in nine, rupture after angioplasty in one). Initial technical success was achieved in the remaining 51 limbs (recanalisation by ring stripper endarterectomy in 36, thrombectomy in 14, both in six, additional intraoperative angioplasty in 42). Five postoperative thromboses were successfully treated by a combined surgical and interventional approach accounting for a 1-month 100% secondary patency. CONCLUSION: Iliac recanalisation through the groin by modified ring stripper endarterectomy or modified thrombectomy in combination with intraoperative angioplasty is a safe and effective procedure. Long-term results are required to evaluate the procedure.     

Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction

Fingertip amputations are the most common type of amputation injury in the upper extremity. These injuries are either seen in the emergency room or in an office setting. These lesions are very frequent and require precise wound care for optimal results. The longer finger and the thumb, being the most distal and independent mobile parts of the hand are affected very often by these kind of injuries. Treatment of fingertip injuries is a continuous focus of controversy among hand and orthopaedic surgeons. Different treatment options have been described, depending on the affected segment and finger, type of lesion, gender and age of the patient, location, size, and depth of the defect. The indications, advantages, and disadvantages of several reconstructive procedures for fingertip injuries have been described. The techniques themselves are not described in detail.