RESUMO
PURPOSE: We report on cutaneous limb manifestations of Kaposi's sarcoma and the secondary infection of these lesions that necessitated five lower-limb amputations. METHOD: The cases are briefly described and prosthetic adaptations in respect to pressure, traction and sweating on the skin are considered. RESULTS: All four patients ambulated initially; one lady died, the double amputee stopped walking owing to the excessive physical demand, and two patients ambulate freely. CONCLUSION: Special considerations to the cutaneous/prosthesis interface are necessary in order to provide these patients with optimal ambulatory ability.
Assuntos
Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/reabilitação , Membros Artificiais/efeitos adversos , Ajuste de Prótese/efeitos adversos , Ajuste de Prótese/métodos , Sarcoma de Kaposi/reabilitação , Sarcoma de Kaposi/cirurgia , Neoplasias Cutâneas/reabilitação , Neoplasias Cutâneas/cirurgia , Idoso , Cotos de Amputação , Evolução Fatal , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Higiene da Pele/métodos , CaminhadaRESUMO
A 52-year-old, trans-femoral amputee with haemophilia was hospitalized because of ambulatory problems arising from the osteo-arthropathic involvement of other major articulations. Reduced function in the upper limbs, caused by the effects of recurrent haemarthroses, resulted in additional problems concerning the usage of auxiliary ambulatory aids. The advantages and disadvantages of traditional and experimental crutches highlight the functional problems of ambulation in persons with concomitant upper limb pathologies.
Assuntos
Muletas/normas , Articulação do Cotovelo/fisiopatologia , Hemofilia A/complicações , Locomoção , Amputados , Membros Artificiais , Fenômenos Biomecânicos , Hemartrose/reabilitação , Hemofilia A/reabilitação , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
Many persons with haemophilia suffer from HIV and receive highly active antiretroviral therapy. Three patients received indinavir and required surgery due to ingrown toenails. Two patients suffered from a traumatic subungual haematoma. The treatment protocol is described whereby the pressure exerted onto the germinal layer and the nail bed is relieved in order to alleviate pain and nail matrix damage.
Assuntos
Hemofilia A/complicações , Doenças da Unha/etiologia , Unhas/patologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Granuloma Piogênico/induzido quimicamente , Granuloma Piogênico/etiologia , Granuloma Piogênico/patologia , Inibidores da Protease de HIV/efeitos adversos , Inibidores da Protease de HIV/uso terapêutico , Hematoma/induzido quimicamente , Hematoma/etiologia , Hematoma/patologia , Hemofilia A/tratamento farmacológico , Hemofilia A/virologia , Hemofilia B/complicações , Hemofilia B/tratamento farmacológico , Hemofilia B/virologia , Humanos , Indinavir/efeitos adversos , Indinavir/uso terapêutico , Pessoa de Meia-Idade , Doenças da Unha/induzido quimicamente , Doenças da Unha/patologia , Unhas/irrigação sanguínea , Unhas/lesões , Unhas Encravadas/induzido quimicamente , Unhas Encravadas/etiologia , Unhas Encravadas/patologia , Transtornos Relacionados ao Uso de Substâncias/patologiaRESUMO
PURPOSE: To determine the reason why 79% of knee disarticulation amputees had not received a prosthesis. METHOD: A 10 year survey was carried out of all patients who had undergone a knee disarticulation at our medical centre. RESULTS: Seventeen of the 37 patients that had not received a prosthesis were recognized to be non-ambulators prior to the surgery. Four patients died after the surgery and in 16 of the patients their general condition limited functional ambulation. An effort had been made to ambulate the patients but had failed. CONCLUSIONS: From a biomechanical point of view many advantages are to be gained for sedentary and bedridden amputees when the level of amputation is through-the-knee.
Assuntos
Desarticulação , Hipocinesia , Prótese do Joelho , Joelho/cirurgia , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-OperatórioRESUMO
The elbow joint is extremely prone to haemarthroses, and when these occur the elbow requires support and rest. Supporting the limb with a simple collar-and-cuff sling, a triangular bandage either with or without a shoulder immobilization device will provide an analgesic effect without adding an unnecessary heavy orthosis. As the swelling subsides and the pain lessens a dynamic orthosis aids in the support and compression. When considering functional branching of the elbow joints there are a number of basic principles to be followed. One requires to consider problems of orthosis suspension, two dimensional motion and stabilization in the functional range of motion. This article provides the rationale for the special needs of persons with haemophilia who suffer from involvement of their elbow joints.
Assuntos
Contratura/terapia , Hemofilia A/complicações , Aparelhos Ortopédicos , Contratura/etiologia , Contratura/fisiopatologia , Cotovelo/fisiopatologia , HumanosRESUMO
A case report is used as an example of how the will of a patient convinced an entire rehabilitation team to alter its assessment of the patient's ambulatory potential. The question of dual dynamics is discussed in the light of the realities of the honest desire and motivation to walk and regain independence.
Assuntos
Amputação Cirúrgica/reabilitação , Motivação , Idoso , Amputação Cirúrgica/psicologia , Atitude do Pessoal de Saúde , Humanos , MasculinoRESUMO
The use of silicone inner sockets, with or without the incorporation of shuttle locks, has greatly improved the function of artificial limbs. They cushion and protect the stump and provide a means for prosthetic suspension, allowing more comfortable use, especially in patients with ischaemic stumps. They also allow greater movement at the proximal joint.
