Diagnostic imaging in lower limb atherosclerosis

At present, there are a number of diagnostic imaging procedures for the evaluation of lower limb atherosclerosis. In particular, MR-angiography with contrast medium and multislice CT are rapidly developing. However, their role in clinical practice is still to be defined. In this article, first, the functional anatomy of peripheral arterial system divided into inflow arteries (aortoiliac trunk), outflow arteries (femoropoplietal trunk) and runoff arteries (leg and foot vessels), is examined. Then, image extraction with color-Doppler US, inflow MR-angiography with contrast material, multislice CT and angiography is briefly illustrated. The corresponding advantages and disadvantages, are indicated. The findings of combined imaging in relation to the various stages of atherosclerosis are analyzed. In particular, intimal thickening leading to occlusion is considered with respect to both morphology and flow alterations. Based on these considerations, the use of the different procedures is discussed in relation to the clinical presentation (no symptoms, claudication or pain, trophic lesions, during postoperative follow-up). For each stage, questions the radiologist should address for a correct approach and the best cost/benefit ratio, are described.     

Leiomyosarcoma of a lower limb presenting with multiple cranial nerve palsies

Leiomyosarcoma is a relatively uncommon soft tissue sarcoma usually presenting as a mass at the primary site. It arises in the retroperitoneal region, in the cutaneous or subcutaneous tissue of the extremities or, less commonly, from a large vein. A case is described where a patient presented with unilateral third, fourth, and sixth cranial, and ophthalmic division of trigeminal nerve palsies in whom biopsy of a longstanding lower limb mass demonstrated leiomyosarcoma. The presentation of this type of pathology has not been described previously.     

Isolated limb infusion for local control of lower limb melanoma: Radiologic aspects

To describe the technical radiological aspects of isolated limb infusion (ILI) to assist those procedural radiologists who carry out ILI on an occasional only basis and to inform the Australian radiologist community about this deserving but relatively little known radiological procedure. Retrospective audit of radiological catheter placement for 23 lower limb ILI procedures carried out for 16 patients with locally recurrent melanoma over 2 years (January 2002 to December 2003). Arterial and venous catheter placement, although sometimes difficult, was successful in all but four occasions. Unfavourable vascular anatomy was the main reason for failure. If approached systematically and with the knowledge of the patient’s vascular anatomy, the outcome will be satisfactory in the hands of the generalist. Knowing the common technical pitfalls will certainly assist. Isolated limb infusion deserves to be more widely known in the radiological and surgical communities.     

5E康复模式对下肢骨肿瘤患者功能恢复及生活质量的影响

目的探讨5E康复模式对下肢骨肿瘤患者下肢功能及生活质量的影响。方法选择2013年3月至2015年3月间于内江市中医医院治疗的86例下肢骨肿瘤患者,随机分为观察组和对照组,每组43例。观察组患者给予常规康复护理和5E康复模式护理,对照组患者给予常规康复护理。比较两组患者的下肢功能、不良情绪及生活质量评分。结果护理干预后,观察组患者的下肢功能评分明显低于对照组;观察组患者的焦虑及抑郁评分均显著低于对照组;观察组患者的生存质量各维度评分均明显高于对照组,差异均有统计学意义(均P<0.01)。结论 5E康复模式能够有效促进下肢骨肿瘤患者下肢功能的恢复,缓解不良情绪,改善生存质量。     

人工特制假体在下肢骨肿瘤保肢治疗中的应用

目的探讨应用人工特制假体在下肢骨肿瘤保肢治疗中的方式和疗效。方法35例下肢骨肿瘤患者,23例行定制带股骨(或胫骨)铰链式膝关节,8例行加长柄人工股骨头置换,4例行加长柄全髋置换。结果治疗后随访9～47个月,平均22个月,生存的30例按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准进行评估。4～5分26例,3分3例,1分1例。结论采用合理的肿瘤边缘完整切除手术,选择特制人工假体并正确安装,辅以综合治疗,能有效提高下肢骨肿瘤保肢率及最大限度保留肢体的功能。     

Low-grade astrocytoma in a child with encephalocraniocutaneous lipomatosis

Encephalocutaneous lipomatosis (ECCL), or Haberland syndrome, is an uncommon congenital disorder with unique cutaneous, ocular and neurological features. In the present article, we describe a 3-year-old boy with ECCL who developed an extensive and recurring intraventricular low-grade glioma with atypical pathological features and elevated mitotic index. Cytogenetic analysis from tumor sample was also performed. This is the first report of a low-grade astrocytoma occurring in a child with ECCL. Whether or not the origin of the tumor is associated to the pathogenesis of the underlying syndrome is a matter for further investigation.     

Reconstruction for lower extremity limb salvage in soft tissue carcinoma

Opinion statement Limb salvage procedures for the lower extremity have a 95% success rate and have essentially supplanted primary amputation as the primary treatment for limb-threatening malignancies. En bloc tumor resection involving major neural and vascular structures that once led to amputation are now successfully reconstructed using free-tissue transfer in combination with neoadjuvant and adjuvant chemoradiation therapies and brachytherapy. Planning for reconstruction of complex lower extremity wounds begins at the time of diagnosis and extends to postoperative rehabilitation. Developing a successful reconstructive plan requires a team approach with accurate assessment of the anticipated loss of critical structures, wound location, defect size, and an understanding of the local and distant tissues available for reconstruction. Comprehensive assessment of the anticipated wound combined with an understanding of the distant and local tissues available for reconstruction allows the reconstructive surgeon to select tissues from the entire body that have improved functional and aesthetic outcomes for patients.     

Magnetic resonance imaging (MRI) lower limb length measurement

An MRI-based method was developed to measure lower limb lengths. By comparison with direct measurement of a cadaver femur, the accuracy of the method was verified as over 99%. Reliability and inter-observer agreement were excellent (correlation coefficients r > 0.99.). This method is accurate and reliable. It shows promise for reducing radiation dose to the paediatric population at large by replacing measurements based on radiographs or computed tomography.     

Current state of extendable prostheses for the lower limb in Japan

With the cooperation of the Japanese Musculoskeletal Oncology Group (JMOG), we conducted a questionnaire survey to assess the status of extendable prosthesis use after resection of malignant bone tumors in children. The subjects were 28 patients (mean age, 10.1 years). Osteosarcoma was the most frequent tumor, and all patients had undergone preoperative chemotherapy and wide resection. The prosthesis was the Growing Kotz-type in 26 patients. The mean predicted leg length discrepancy was 67.7mm, mean stem diameter 10mm, mean number of elongations 2.1, and mean total elongation 35.4mm. Infection was observed in one patient with a mean functional assessment of 75%. In Japan, extendable prostheses, as represented by the Growing Kotz-type, provide a useful limb reconstruction method, with a minimum of major complications and with good function of the affected limb. However, a long-term follow-up survey is necessary.     

Prosthetic rehabilitation of persons with lower limb amputations due to tumour

The retrospective study was to analyse some characteristics of patients with lower limb amputations due to tumour, as well as the prosthetic rehabilitation. From 2000 to 2004, we observed 46 patients (25 men and 21 women) who were admitted prosthetic rehabilitation after a lower limb amputation due to tumours. We examined their medical documentation and recorded their general clinical status paying a special attention to the local status of the stump. The average age of patients was 51 +/- 17.11 years. Osteosarcoma was the most frequent cause in 26%. The trans-femoral amputation was in 50% and the knee disarticulation was in 8.7%. The average duration of prosthetic rehabilitation was 35 +/- 7.94 days. The average daily use of the prosthesis was 5.5 h. At the time of admission for rehabilitation, 10.9% of patients were using wheelchairs, 8.7% were using walkers and 80.4% were using two crutches to assist their walking abilities, whereas at the time of discharge 89.1% of patients used two crutches and 4.4% used one crutch for assistance, while 6.5% were able to walk unassisted. The adequate prosthetic rehabilitation in patients with lower limb amputations due to tumour is important preconditions for reintegration into the family and community.     

Growth in the lower limb following chemotherapy for a malignant primary bone tumour: a straight-line graph

Purpose. The aim of this paper was to assess the growth in the unaffected lower limb of children who had received chemotherapy for a malignant primary bone tumour around the knee.Subjects/methods. Following diagnosis, all children (45, of which 32 were boys and 13 were girls) were staged. If limb-salvage surgery was thought appropriate, measured radiographs of both legs was performed, the bone age was estimated and the expected growth in the femur and tibia was calculated according to Tupman. These procedures were repeated at follow-up and the data plotted. Regression and correlation coefficients were also calculated.Results. The observed regression line in boys was almost identical to Tupman's curve. However, the observed growth in girls was larger than the expected growth.Discussion. It is recommended that the regression lines presented here are used in the calculation of the expected growth in the lower limb of children who have received chemotherapy for a malignant primary bone tumour, especially in girls.     

对血管性疾患所致下肢截肢问题的探讨

近20年来,造成截肢的原因在逐渐地发生着变化,因为周围血管病或同时合并糖尿病而截肢者已越来越多见,尤其是在西方国家,在美国已占截肢发生率的50%     

Dramatic reduction of chronic lymphoedema of the lower limb with sorafenib therapy

This paper describes an interesting case report based on a patient who had a dramatic and astounding reduction in her chronic lymphoedema while on sorafenib.     

Amputation of the lower limb as palliative treatment for debilitating musculoskeletal cancer

Limb sparing surgery has replaced amputation surgery for treating sarcomas of the lower limb in most cases. Wide resection followed by postoperative radiation therapy can achieve acceptable local control and survival rates in patients with bone and soft-tissue sarcomas of the lower limb. Recurrent or persistent disease constitutes a major oncological problem. Local symptoms such as agonizing pain, fractures, tumor fungation, inability to walk and inability to maintain daily activities, further impair the patient's quality of life. In this clinical set-up palliative amputation of the limb should be considered. Fourteen patients with soft-tissue or bone sarcomas underwent palliative major amputation. The procedures included: hemipelvectomy, hip disarticulation, knee disarticulation, above or below-knee amputation. Local control of the disease and pain, and improvement of the performance status were observed in 13 evaluable patients. The mobility was restored in 13/14 patients. The median survival following the procedure was 9 months. There was only one case of immediate post-operative death. Severe phantom pain was not reported by any of the patients. Quality of life was reported to be improved by two-thirds of the patients. We found palliative major amputation surgery worth-performing in low-performance status cancer patients with locally advanced disease of the lower limb.     

Epiphysis preserving operations for the treatment of lower limb malignant bone tumors

Purpose

To assess two epiphyseal sparing procedures for the treatment of lower limb malignant bone tumors.

Methods

Between January 2007 and January 2011, 15 patients, seven males and eight females with a mean age of 11.75 years (range, 7–24), underwent epiphysis preservation operations. There were ten osteosarcomas, three Ewing's sarcomas and two fibrosarcomas. Ten tumors were in the distal femur and five in the proximal tibia. Chemotherapy was administered pre- and post-surgery. A transepiphyseal resection was performed in nine patients and an epiphysis section after physeal distraction in six. The affected bones were substituted with massive allograft bone and fixed with intramedullary nails or plates and screws. Follow-up assessment included plain X-rays and MRI.

Results

One patient died from lung metastases 32 months post-surgery. Surgical complications included length discrepancy between both legs of 1–3 cm in four patients, >3 cm in one patient, delayed union at the proximal allograft-host junction in two patients and at the distal junction in 13 patients. Graft bone rejection occurred in two patients, superficial infection was seen in one patient, and broken fixation and partial graft bone resorption occurred in one patient. No relapse was observed during the follow-up period. Normal knee joint flexion-extension was achieved in 14 patients. All patients were able to walk unaided 24 months after surgery.

Conclusions

Limb saving surgery with epiphyseal sparing is useful for the management of malignant bone tumors in children and adolescents, and maintains normal joint function with few complications.     

The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients

ObjectiveLower limb lymphedema (LLL) is a common postoperative complication among gynecological oncology patients following lymph node resection. In the absence of a screening strategy, LLL is frequently diagnosed only through patient's self-reported symptoms. This study investigated the prevalence of undiagnosed postoperative LLL among gynecological oncology patients and identified the associated risk factors.Materials and methodsThis was a cross-sectional postal questionnaire survey at a tertiary gynecological oncology center. Women with gynecological malignancies who underwent lymph node (inguinal/pelvic/para-aortic) resection between 2010 and 2017 were eligible. The Gynecological Cancer Lymphedema Questionnaire (GCLQ) was used and those with a score of ≥4 were referred to a lymphedema specialist for clinical confirmation.ResultsAmong 376 eligible women, postoperative LLL was already diagnosed in 45/376 (12%) women. In the remaining women, 117/331 (35.3%) completed the GCLQ, of which 67/117 (57.3%) scored ≥4. Fifty-five women (55/67, 82.1%) were assessed by a lymphedema specialist and eight cases of postoperative LLL were confirmed. In the 12/67 who declined a clinical assessment, they reported no evidence of LLL. The prevalence of undiagnosed postoperative LLL in our study was 8/117 (6.8%, 95% C.I. 2.3–11.4). On univariate analysis, older women were more likely to have undiagnosed postoperative LLL.ConclusionsUndiagnosed postoperative LLL is not uncommon among gynecological oncology patients, especially in older patients. No vulvar cancer patient had undiagnosed LLL. Increased awareness and improved strategies for lymphedema screening are required after lymph node surgery in gynecological oncology.