Factores diferenciales entre desistimiento individual y colectivo de mujeres de las FARC-EP en prisión / Differential factors between individual and collective desistance of FARC-EP women in prison / Fatores diferenciais entre a desistência individual e coletiva das mulheres das FARC-EP na prisão

Para el año 2017 se encontraban vigentes en Colombia dos marcos jurídicos para promover el desistimiento y desarticulación de las FARC-EP. Los dos, aunque desde contextos diferentes, han promovido, por un lado, el desistimiento individual y por otro, el desistimiento colectivo de sus miembros. Las mujeres han sido partícipes de ambos procesos, desde la libertad o la prisión de manera minoritaria y asimétrica en comparación con los hombres. Con el interés de analizar este fenómeno, el presente estudio buscó identificar los factores que llevaron a las mujeres a desistir según una u otra modalidad y de-terminar diferencias y similitudes. Para este propósito se diseñó un modelo probabilístico que captara las relaciones de causalidad entre desistimiento y factores predichos desde las teorías del aprendizaje social, de la elección racional y del control social informal, en una muestra de mujeres farianas en prisión que desistieron de forma individual y colectiva. Se encontró que factores como pertenecer a un rango de edad entre 20 y 31 años, tener pareja y haber participado en delitos graves, asociados al terrorismo, influyeron en la selección de la modalidad individual, mientras que tener más de 31 años, participar en delitos comunes junto a los asociados con el terrorismo, incluyendo el narcotráfico, y proceder de regiones con historia de conflicto arraigada predijeron el desistimiento colectivo.

By 2017, there were two legal frameworks in force in Colombia to promote the disbanding and dismantling of the FARC-EP. Both, although from different contexts, have promoted, on the one hand, the individual disbandment and, on the other, the collective disbandment of its members. Women have participated in both processes, from freedom or prison, in a minority and asymmetrical manner compared to men. In order to analyse this phenomenon, this study sought to identify the factors that led women to desist in one or the other modality and to determine differences and similarities. For this purpose, a probabilistic model was designed to capture the causal relationships between desistance and factors predicted from the theories of social learning, rational choice and informal social control, in a sample of women in prison who desisted individually and collectively. It was found that factors such as belonging to an age range between 20 and 31 years, having a partner and having participated in serious crimes associated with terrorism, influenced the selection of the individual modality, while being over 31 years old, participating in common crimes along with those associated with terrorism, including drug trafficking, and coming from regions with a history of deep-rooted conflict predicted collective desistance.

Até 2017, havia duas estruturas legais em vigor na Colômbia para promover a dissolução e o desmantelamento das FARC-EP. Ambos, embora de contextos diferentes, têm promovido, por um lado, a dissolução individual e, por outro, a dissolução coletiva de seus membros. As mulheres participaram de ambos os processos, da liberdade ou da prisão, de forma minoritária e assimétrica em relação aos homens. A fim de analisar este fenômeno, este estudo procurou identificar os fatores que levaram as mulheres a desistir em uma ou outra modalidade e determinar diferenças e semelhanças. Para este fim, um modelo probabilístico foi projetado para capturar as relações causais entre a desistência e os fatores previstos a partir das teorias de aprendizagem social, escolha racional e controle social informal, em uma amostra de mulheres na prisão que desistiram individual e coletivamente. Constatou-se que fatores como pertencer a uma faixa etária entre 20 e 31 anos, ter um parceiro e ter participado de crimes graves associados ao terrorismo, influenciaram a seleção da modalidade individual, embora tendo mais de 31 anos de idade, participar de crimes comuns juntamente com aqueles associados ao terrorismo, incluindo o tráfico de drogas, e vindo de regiões com um histórico de conflitos profundamente enraizados preveram a desistência coletiva.

Primer reporte de una cirugía ortopédica en Cienfuegos, historia de un caso del siglo XIX / First Report Of An Orthopedic Surgery In Cienfuegos, History Of A Case Of The XIX Century

En el trabajo se describe una desarticulación escápulo-humeral y probablemente la primera cirugía ortopédica realizada en Cienfuegos. La operación fue dirigida por Luis Perna de Salomó en un período con grandes avances en la rama de la medicina. En el estudio se emplean métodos de la investigación histórica como el heurístico, para la búsqueda de información documental relacionada con el suceso; el histórico-lógico, junto al inductivo-deductivo y el analítico-sintético, entre otros. Esta intervención quirúrgica fue de relevancia local por el alto nivel científico que precisaba su ejecución y confirma la necesidad de estudiar las técnicas y prácticas médicas empleadas en Cienfuegos durante el siglo XIX(CU)

The paper describes the performance of what was probably the first orthopedic surgery in Cienfuegos: a scapulo-humeral disarticulation. The surgery was performed by a group of doctors headed by Luis Perna de Salomó, in a period in which great advances were taking place in the branch of medicine. In this study, historical research methods are used, such as the heuristic -in search of locating primary and secondary documentary information related to the event-, the historical-logical, together with the inductive-deductive and the analytical-synthetic, among others. The surgical intervention carried out, due to its local relevance and the high scientific level that needed to be mastered to perform it, evidences the need to study the medical techniques and practices used in Cienfuegos on that date, which, as can be seen, were at the height of those carried out in the capital of the island. Due to the local relevance it had, and the high scientific level that needed to be mastered to perform it, this surgical intervention evidences the need to study the medical techniques and practices used in Cienfuegos on that date, which, as can be seen, were at the height of those made in the capital of the island(CU)

Protetización temprana y seguimiento de paciente pediátrico con hemimelia tibial / Early Fitting and Follow-Up of A Pediatric Patient with Tibial Hemimelia

Introducción: La hemimelia tibial es una entidad poco frecuente, presente hasta en 1:1.000.000 nacidos vivos. Tiene una asociación genética autosómica recesiva, y se presenta con cambios en la morfología del miembro inferior con una tibia ausente o presente parcialmente, además de cambios en peroné, rodilla y pie. Según su clasificación se puede manejar con reconstrucción quirúrgica de la extremidad o amputación. La posibilidad de una prótesis temprana favorece el resultado funcional del paciente y su adaptación protésica. Objetivo: Presentar el caso de una entidad poco común tratada con desarticulación a nivel de la rodilla y prótesis por su grado de compromiso. Presentación de caso: Paciente femenina de tres años con compromiso del miembro inferior derecho. Los primeros años usó una prótesis artesanal fabricada por su familia. Fue valorada por la Junta Médica de rehabilitación y ortopedia que decidió intervención quirúrgica para desarticulación de la rodilla. Se realizó protetización temprana en busca de beneficios de cicatrización, control del edema y adaptación postquirúrgica. Se realizan controles posteriores con ajustes a la prótesis de acuerdo con las necesidades propias de la edad de la paciente. Conclusiones: Se muestra una adecuada evolución postquirúrgica, sin dolor o neuropatía, con un reinicio temprano de la marcha y progreso adecuado de su neurodesarrollo e integración social, lo que da una pauta de manejo en paciente pediátrico con este tipo de deformidades(AU)

Introduction: Tibial hemimelia is a rare entity, reported in up to 1:1,000,000 live births. It has an autosomal recessive genetic association, and it presents with changes in the morphology of the lower limb with an absent or partially present tibia, as well as changes in the fibula, knee, and foot. Depending on its classification, it can be managed with surgical reconstruction of the limb or amputation. The possibility of an early prosthesis favors the functional result of the patient and his prosthetic adaptation. Objective: To report the case of a rare entity treated with knee disarticulation and prosthesis due to its degree of compromise. Case report: The case of a three-year-old female patient with compromise of the lower right limb is reported here. The first years she used a handmade prosthesis made by her family. She was assessed by the Medical Board of Rehabilitation and Orthopedics, which decided to undergo surgery for knee disarticulation. Early fittings were performed in search of healing benefits, edema control and post-surgical adaptation. Subsequent controls were carried out with adjustments to the prosthesis according to the needs of the patient's age. Conclusions: An adequate post-surgical evolution is shown, without pain or neuropathy, with early resumption of gait and adequate progress of their neurodevelopment and social integration, which provides recommendation for management in pediatric patients with this type of deformity(AU)

Understanding Experiences of Young Adult Males with Below-Knee Amputation

@#PURPOSE: This study was done to explore the experiences of young adult males with below-knee amputation at surgical wards and clinics in Teaching Hospital, Kurunegala, Sri Lanka. DESIGN: The study used the phenomenology design of qualitative research. METHODS: Face-to-face interviews were conducted for data collection using a theme list with a saturation point reached at 16 participants. The duration of an interview was 30-45 minutes and was recorded on audiotape and transcribed later. Phases of familiarization with the data, coding, searching for themes, reviewing themes, defining and naming themes, and writing up were conducted accordingly to thematic analysis. FINDINGS: The young adult male below-knee amputees showed changes in lifestyle with dependence on others, supporting aids, and experiencing discomfort. They showed mental distress with dissatisfaction with life and suffering of life. Additionally, they lacked power with identity changes and encounter economic problems in their lives. CONCLUSIONS AND RECOMMENDATIONS: It is essential to give special education to the staff caring for the below-knee amputees to minimize their unpleasant and challenging experiences. Health staff can motivate family members and friends for individuals' mental adjustment to their new life. Additionally, the social attitude of the community should be changed positively regarding amputated patients.

Lesiones complejas en pie diabético neuroinfeccioso y su tratamiento con Heberprot-P® / Complex lesions in neuroinfectious diabetic foot and its treatment with Heberprot-P®

La prevalencia mundial del pie diabético oscila en un 6,4 por ciento. La amputación en personas con diabetes es de 10 a 20 veces más frecuente que en los no diabéticos y, cada 30 segundos, en algún lugar del mundo alguien sufre la amputación de una extremidad inferior como consecuencia de esta. El Heberprot-P® constituye un producto indicado y registrado por Cuba para el tratamiento de pacientes con úlceras neuropáticas y neuroisquémicas del pie diabético, que en este caso resulta una lesión compleja, en estado avanzado y con alto riesgo de amputación (Wagner 4). Este estudio tuvo como objetivo presentar un caso que demuestra la eficacia de la cicatrización de una lesión compleja del pie diabético mediante el tratamiento con Heberprot-P®. Se trata de un paciente de 47 años, diabético de tipo 1, que ingresó en el Hospital "Dr. Mario Muñoz Monroy" de la provincia de Matanzas, en 2017, con el diagnóstico de pie diabético neuroinfeccioso, y lesiones en primer dedo y base plantar de todos los dedos (grado 4, según clasificación de Wagner). Se le realizó desarticulación del primer dedo y necrectomía plantar. Posteriormente, previo control metabólico y de la sepsis, se le hicieron 21 infiltraciones de Heberprot-P® (75 µg) en un período de 45 días. Finalmente, se logró una epitelización de aproximadamente un 95 por ciento de la lesión. De este modo, quedó mostrada la eficacia en la cicatrización de lesiones complejas del pie diabético mediante el uso del Heberprot-P®(AU)

The global prevalence of diabetic foot ranges from 6.4 percent. Amputation in people with diabetes is 10 to 20 times more common than in non-diabetics and every 30 seconds somewhere in the world someone suffers the amputation of a lower limb as a result of diabetes. Heberprot-P® constitutes a product indicated and registered by Cuba for the treatment of patients with neuropathic and neuroischemic ulcers of the diabetic foot, which in this case results in a complex injury, in advanced state and with high risk of amputation (Wagner 4). This study aimed to present a case that demonstrates the effectiveness of healing from a complex diabetic foot wound treated with Heberprot-P®. It was the case of a 47-year-old male diabetic type 1 patient who was admitted at "Dr. Mario Muñoz Monroy" Hospital in Matanzas province, in 2017, with the diagnosis of neuroinfectious diabetic foot, and lesions in the first finger and plantar base of all fingers (grade 4, according to Wagner's classification). It was conducted a disarticulation of the first toe and a plantar necrectomy. Subsequently, after metabolic control and sepsis, 21 infiltrations of Heberprot-P® (75 g) were made over a period of 45 days. Finally, an epithelialization of approximately 95 percent of the wound was achieved. In this way, the effectiveness in healing complex lesions of the diabetic foot was shown through the use of Heberprot-P®(AU)

Caracterização das pessoas amputadas de um hospital de grande porte em Recife (PE, Brasil) / Characterization of amputees at a large hospital in Recife, PE, Brazil

A amputação de membros pode ser definida como um procedimento que consiste em separar do corpo um membro ou segmento dele. Objetivos Descrever o perfil dos procedimentos de amputações de membros realizados em um hospital estadual de grande porte. Métodos Estudo transversal do tipo descritivo e retrospectivo realizado em um hospital de grande porte da cidade de Recife (PE). Os dados foram coletados em registros de pacientes que foram submetidos à amputação no ano de 2017. Foram incluídos pacientes que tiveram seu membro amputado em 2017 e excluídos aqueles com informações ilegíveis ou incompletas. Resultados Foram realizados 328 procedimentos em 274 pacientes, a maioria do gênero masculino (57,7%). Houve predominância de amputações em membros inferiores (64,2%), de causa não traumática (86,5%) e atendimentos de urgência (96,4%). A maioria dos pacientes submetidos a amputações ficaram internados por um período de 11 a 25 dias (32,1%). Este estudo mostrou que a maioria das pessoas amputadas recebeu alta (69,7%) e uma parte foi a óbito, sendo os óbitos, no caso das amputações de membros inferiores, principalmente de pessoas idosas na faixa etária de 60 a 90 anos (76%), do sexo feminino (55%), e submetidas a uma amputação (91%). Conclusões Os dados apresentados neste estudo são alarmantes, principalmente ao se considerar que muitas das amputações poderiam ter sido evitadas, visto que foram decorrentes de complicações de doenças cuja prevenção e controle podem ser realizados em outros níveis de complexidade do sistema e com custo relativamente baixo

Limb amputation can be defined as a procedure that consists of separating a limb or a segment of a limb from the body. Objectives To describe the profile of limb amputation procedures performed at a large hospital run by the state of Pernambuco (Brazil). Methods Cross-sectional descriptive and retrospective study conducted at a large hospital in the city of Recife, PE. Data were collected from the records of patients who underwent amputations during 2017. Records from patients who had had a limb amputation during 2017 were included, unless data were illegible or missing. Results A total of 328 procedures were performed on 274 patients, the majority of whom were male (57.7%). There was a predominance of lower limb amputations (64.2%), of non-traumatic causes (86.5%), and urgent treatment (96.4%). The majority of patients who underwent amputations remained in hospital for 11 to 25 days (32.1%). The study found that the majority of amputees were discharged (69.7%), although a proportion died. Deaths of lower limb amputees were primarily among elderly women in the age range of 60 to 90 years (76%), females (55%), and patients subjected to a single amputation (91%). Conclusions The data observed in this study are alarming, particularly considering that many of these amputations could have been avoided, since they were caused by complications of diseases that can be prevented and controlled at healthcare services of a lower level of complexity and at a relatively low cost

Diseño de exoesqueletos para miembro inferior / Exoskeleton design for lower limb

Introducción: La desarticulación de cadera es realizada por cirujanos para prevenir el crecimiento de enfermedades malignas en casos que no pueden ser tratados en forma conservadora. Existe la posibilidad que la desarticulación pueda ser causada por un accidente traumático que comprometa uno o los dos miembros inferiores. Objetivo: modificar el diseño de una prótesis para personas con problemas de tensión muscular, para cargas pesadas y movimientos repetitivos, para ser usada en personas con desarticulación unilateral o bilateral de cadera, partiendo de la patente de invención. Métodos: El diseño se realizó teniendo en cuenta desplazamiento similar al sistema locomotor humano, el confort, las posibles lesiones en las prominencias óseas, la repetitividad y el bajo costo. Para garantizar el menor impacto en la prominencia ósea disminuyendo el riesgo de ruptura o ulceras se usó un escáner 3D con sensores de presión para una correcta distribución de la presión sobre toda la prominencia de la cadera. Resultados: El sistema propuesto resultó en una alternativa para personas con limitaciones de movilidad en miembro inferior permitiendo un movimiento más natural y así mejorar la calidad de vida de este tipo de pacientes. La técnica permitió al usuario un alto nivel de independencia en situaciones de pérdida de los miembros inferiores. Conclusiones: El estudio se centró en la modificación de una prótesis para miembro inferior usado para personas con baja tonicidad muscular o actividades repetitivas a un sistema para personas con desarticulación bilateral de cadera o pérdida de un solo miembro inferior(AU)

Introduction: Hip disarticulation is performed by surgeons to prevent the growth of malignant diseases in cases that can not be treated conservatively. There is a possibility that the disarticulation may be caused by a traumatic accident involving one or both lower limbs. Objective: to modify the design of a prosthesis for people with muscular tension problems, for heavy loads and repetitive movements, to be used in people with unilateral or bilateral hip disarticulation, starting from the patent of invention. Methods: The design was made taking into account displacement similar to the human locomotor system, comfort, possible lesions in bony prominences, repetitiveness and low cost. To guarantee the least impact on the bone prominence, reducing the risk of rupture or ulcers, a 3D scanner with pressure sensors was used to correctly distribute the pressure over the whole hip prominence. Results: The proposed system resulted in an alternative for people with mobility limitations in the lower limb allowing a more natural movement and thus improving the quality of life of this type of patients. The technique allowed the user a high level of independence in situations of loss of the lower limbs. Conclusions: The study focused on the modification of a lower limb prosthesis used for people with low muscle tone or repetitive activities to a system for people with bilateral hip disarticulation or loss of a single lower limb(AU)

Extracorporeal Shock Wave Therapy For Treatment of Intractable Stump Pain

Amputation stump pains can be developed in amputation sites after high voltage electrical burn injuries. We experienced one case of these severe stump pains in an upper extremity amputation patient. A 35-year-old man had a 38% total body surface area high voltage electrical burn. The patient underwent skin grafting and left shoulder disarticulation. During the rehabilitation period, he complained about severe stump area pains and phantom pains. We injected 0.5% Bupivacaine and Triamcinolone on the stump neuroma site but the pain sustained. After extracorporeal shock wave therapy (ESWT,) the pain subsided and did not recur. The patient was satisfied with functional and pain outcomes, so we report this case.

A Patient with Multiple Unfavorable Reconstruction Options: What Is the Best Choice?

The method of lower limb reconstruction surgery is selected based on a patient's underlying conditions, general conditions, and wound status, and it usually varies from direct closure to skin graft and flap coverage. Herein, we describe a patient with Duchenne muscular dystrophy who developed critical limb ischemia after femoral cannulation for extracorporeal membrane oxygenation was used during knee disarticulation, which was followed by reconstruction of the defect around the knee using a pedicled anterolateral thigh flap and skin graft.

First Report of Yokenella regensburgei Isolated from the Wound Exudate after Disarticulation Due to Diabetic Foot Infection in Korea / 대한임상미생물학회지

Yokenella regensburgei, a member of the family Enterobacteriaceae, is rarely isolated in humans. Here, we report a 71-year-old man with diabetic foot infection from which Y. regensburgei was isolated. Following debridement and disarticulation of the foot, an exudate specimen was obtained, from which Gramnegative bacilli were recovered. The organism was identified as Y. regensburgei using the Vitek 2 system (bioMerieux, USA) and 16S rRNA and gyrB gene sequencing. To our knowledge, this is the first case of Y. regensburgei isolation in Korea.

Eighteen Year Follow-Up Results of Accessory Lower Limb Disarticulation and Pelvic Bone Reconstruction for Monocephalus Tripus Tribrachius / 대한정형외과학회잡지

Monocephalus tripus tribrachius, a type of conjoined twins with one head and three upper and lower extremities, is a rare congenital disorder. To date, no long-term follow-up results of surgical procedures for this condition have been reported in Korean literature. We experienced a case of monocephalus tripus tribrachius, which had been surgically managed with an accessory lower limb disarticulation and pelvic bone reconstruction to manage this accessory limb and accompanying comorbidities in hip joint and pelvis. Subsequently, ipsilateral Syme amputation was done for intractable deformity of foot, and later, ipsilateral femoral varus derotational osteotomy was done for inadequate coverage of femoral head observed in follow-up. We report 18-year follow-up results of the procedures with a review of literatures.

Hip disarticulation, report of 3 cases and literature review

Hip disarticulation is a rarely performed procedure and few surgeons are expert in doing it, the operation may be needed urgently for a sick unstable patient. We present three cases of hip disarticulation for severe infection, vascular disease and chondrosarcoma in which we were involved over a short period of time and a literature review to discuss the success and mortality of this procedure. Hip disarticulation accounts for 0.5% of lower extremity amputations and mostly performed for malignant musculoskeletal tumors, limb ischemia, infections and trauma. It has a poor functional outcome but it may be the only available option to cure the patient or save his life. Hip Disarticulation is a major complex surgery and should be part of the armamentarium of the orthopaedic surgeon who is treating severe lower limb infections, dealing with lower limb sarcomas and peripheral vascular diseases. It is a major procedure for the patient. It should not be undertaken lightly and patient and surgeon need to know the likely outcome

Through Knee Amputation: Technique Modifications and Surgical Outcomes

BACKGROUND: Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center. METHODS: A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified. RESULTS: Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four trans-femoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01. CONCLUSIONS: Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

Stepwise Rehabilitation of the Triple Amputee Combined With Dysfunction of the Sound Limb

To find a multiple amputee more severe than a triple amputee is not easy. This is a report of a 36-year-old patient with right knee disarticulation, left trans-femoral amputation and right elbow disarticulation due to peripheral ischemic necrosis, when he was applied vasopressor in septic shock condition. His left hand was also 2nd, 3rd, 4th, and 5th distal interphalangeal joint disarticulation status, and it was more difficult for him to do rehabilitation program, such as donning and doffing the prostheses. For more efficient rehabilitation training program, we first focused on upper extremities function, since we believed that he might need a walking aid for gait training later. After 13 weeks of rehabilitation program, he has become sit to stand and walk short distance independently with an anterior walker. Although he still needs some assistance with activities of daily living, his Functional Independence Measure score improved from 48 to 90 during the course of 13 weeks.

Treatment of Large Arteriovenous Malformation in Right Lower Limb

A 10-year-old boy with arteriovenous malformation (AVM) of the right lower limb was scheduled for an amputation of the affected limb. Limb amputation was necessary because of the ineffectiveness of previous sclerotherapy and the rapid progression of AVM causing pain and heart failure. Right hip disarticulation was considered the best option to improve his quality of life. To prevent congestive heart failure and uncontrollable hemorrhage during surgery, the disarticulation was done under a partial cardiopulmonary bypass. The patient underwent surgery successfully without complications.

Reconstrução após ressecção extensa de tumor das cinturas pélvica e escapular: relato de dois casos / Reconstruction following extensive tumor resection of the pelvic and scapular girdle: a report of two cases

As cirurgias radicais para tratamento dos tumores da cintura pélvica e escapular (hemipelvectomias e desarticulações interescapulotorácicas) constituem-se, em geral, em procedimentos extensos com grandes áreas de perda de substância local após ressecção do tumor. A utilização do retalho que inclui toda a musculatura anterior e posterior da coxa após dissecção do fêmur, pediculado pelos vasos femorais superficiais, foi descrita apenas uma vez na literatura. O retalho similar utilizando toda a musculatura anterior e posterior do braço após dissecção do úmero, pediculado pelos vasos subclávios para reconstrução após desarticulação interescapulotorácica, não apresenta relatos. Descrevemos dois casos - um de hemipelvectomia e outro de desarticulação interescapulotorácica - utilizando estes dois retalhos para fechamento do defeito.

Radical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases - one hemipelvectomy and one interscapulothoracicl amputation - using these two the flaps to close the defect.

Metastatic Hepatocellular Carcinoma to the Distal Phalanx: a Case Report and Review of Literature / 한국호스피스완화의료학회지

Metastatic tumors to the hand are rare and often overlooked by clinicians. Here, we report a rare case of phalangeal metastasis of right 4th finger in a patient with hepatocellular carcinoma. Treatment was given with right 4th finger disarticulation. This report suggests that physicians must take consideration into the possibility of metastatic tumors in patients with bone lesions on hands and a history of malignancy.

Coverage of Electrically Burned Upper Extremity Amputation Stumps by a Pedicled Latissimus Dorsi Flap

PURPOSE: In cases of high voltage electrical burns, a wound occurs as current enters or leaves the body and is accompanied by deep tissue injury. If upper extremity amputation is inevitable, consideration should be given to the residual limb functions, secondary reconstruction, and wearing of an upper prosthesis. Our hospital has achieved satisfactory outcomes through the use of a pedicled latissimus dorsi (LD) flap in patients undergoing transhumeral amputation and shoulder disarticulation due to upper extremity damage from high voltage electrical burns. METHODS: The study was targeted to five patients who suffered high voltage electrical burns, underwent above-elbow amputation, and were reconstructed in the acute and secondary phases using a pedicled LD flap from January 2005 to December 2011. All patients underwent equilateral pedicled LD flap surgery, with primary closure at the donating site. RESULTS: The average age of patients was 49.6 years (38~64); they were all male. One patient underwent sublayer skin grafting after a pedicled muscular LD flap, and four patients had a pedicled myocutaneous LD flap: one patient among the four had a forearm flap after the pedicled myocutaneous LD flap. All flaps were well adhered, and post-surgical flap reduction and local flaps were performed for adequate sizing and aesthetic improvement. CONCLUSION: In cases of upper arm amputation due to wide upper extremity damage caused by electrical burns, the use of the pedicled LD flap and adequate amputation length made subsequent wearing of a prosthesis possible. The pedicled LD flap procedure allowed reconstruction of a relatively large area of soft tissue and the surgery to the donating site was unproblematic.

Para desarticular os estratos dominantes do organismo, da significância e da subjetivação / Dislocating the dominant stratums of the organism, significance and subjectification

O presente artigo tem como objetivo abordar os três principais estratos a que estamos mais diretamente submetidos em nossa cultura, a saber: o organismo, a significância e a subjetivação, tais como definidos por Deleuze e Guattari em Mil Platôs. Os autores indicam que é preciso deslocar a ênfase desse conjunto de estratos molares para um novo foco: ao invés do sujeito fixado a representações transcendentes, que deve ser intérprete e é interpretado com seus “significados secretos”, e que vê seu corpo submetido a se apresentar como um organismo organizado de acordo com modelos normatizados, devemos nos voltar para a vida e seu processo de atualização, que não pode ficar restrito a limites tão estreitos e estanques. Pretende-se apontar a forma como a psicanálise mais tradicional participa mais de uma política de limitação do que de libertação de tais estratos, ao vincular o inconsciente à necessidade da interpretação e ao acorrentar a tradução do desejo às estruturas do Édipo e da castração, desconsiderando, assim, a singularidade das experiências existenciais e a multiplicidade de sentidos que elas podem ter. Por meio da análise da desarticulação dos estratos proposta pelos autores, poderão ser percebidas novas possibilidades, mapas e percursos desidentificados, encontrados, por exemplo, no discurso das crianças, em que se pode notar que o transcendente é substituído pelo transcendental.

The present article aims to discuss the three main stratums to which we are mostly submitted in our culture, namelythe body, the significance and the subjectification as defined by Deleuze and Guattari in A Thousand Plateaus. The authors suggest that we must shift the emphasis from this molar stratums to a new focus: instead of the subject set totranscendental representations, that needs to be an interpreter and is also interpreted with their "secret meanings", with their body having to present it self as an organized body according to standardized models, we should direct our attention to life and its updating process, which cannot be restricted to limits so narrow and tight. We intend to point out the way in which classical psychoanalysis takes part in a policy of limitations more than of liberation of these stratums, by linking the unconscious to the need of interpretation and by submitting the translation of desire to the structures of Oedipus and castration, without considering the singularity of the existential experiences and the multiplicity of meanings that they can have. Through the analysis of the dislocation of the stratums proposed by the authors, it will be possible to realize new opportunities, maps and unidentified routes that can be found, for example, in the speech of children, where we can see that the transcendent is replaced by the transcendental.