自制消毒架在下肢手术中的应用

我院自行设计并制作的简易消毒架,经5年临床实践,效果满意。现介绍如下。1材料与结构自制消毒架底座用不锈钢注入混凝土制成重量10kg、直径30cm的2个圆盘,在圆盘下面安装4个万向制动滑轮。竖杆分两截,下段用直径3cm、长60cm的不锈钢管,上段用直径略细、长60cm的不锈钢管(正好可     

Bilateral lower extremity evaluation of deep venous thrombosis with color flow and compression sonography.

Recognition of the accuracy of CUS for diagnosis of DVT has led to increased requests for bilateral lower extremity CUS studies. Compared to unilateral lower limb CUS studies, these examinations are often requested when the clinical suspicion of DVT is less strong. We undertook a 15 month prospective study of bilateral lower extremity CUS examinations to determine the diagnostic yield of positive studies and any correlation with clinical parameters. Eighty-six patients were studied; six patients (7%) had studies positive for acute DVT, and 78 patients (91%) had negative studies. Positive studies did not correlate with clinical parameters except erythema. Concurrently, 23% of unilateral lower limb sonographic studies were positive. Bilateral lower limb CUS is a low yield investigation, which may be indicated in view of the morbidity and mortality associated with DVT and pulmonary embolism.     

中药换药治疗下肢皮肤溃疡的护理

慢性皮肤溃疡（CSU）又称难治性溃疡,是一种常见的难治性疾病,它包括血管性溃疡、压迫性溃疡、放射性溃疡、感染性溃疡,以下肢、足部为好发的部位Ⅲ。由于此类伤口久治不愈,不仅会增加患者的痛苦,还会加重患者的经济负担。     

新型敷料治疗下肢静脉性溃疡的效果观察

[目的]观察爱康肤银离子抗菌敷料和凝胶泡棉敷料治疗下肢静脉性溃疡的疗效。[方法]将60例下肢静脉性溃疡病人随机分为观察组和对照组,观察组(30例)采用爱康肤银离子抗菌敷料和凝胶泡棉敷料治疗,对照组(30例)采用传统凡士林纱布治疗。观察两组病人伤口愈合率、治疗前后伤口面积变化、周围皮肤浸渍情况。[结果]观察组愈合率高于对照组,治疗后伤口缩小明显,周围皮肤浸渍率低于对照组。[结论]爱康肤银离子抗菌敷料和凝胶泡棉敷料能有效控制伤口细菌感染,避免大量渗液对周围皮肤浸渍,减少换药次数。     

Rotational problems of the lower extremity.

Rotational abnormalities in the lower extremities are common in the growing child, but they seldom represent any serious handicap in adult life. When confronted with such a problem, the physician should carefully rule out any underlying pathologic abnormality and should approach the problem in a step-wise fashion. The component parts of the lower extremity should be examined carefully and individually to assess their role in the rotational problem. The usual causes of internal rotation problems, or toeing in, are metatarsus adductus, internal tibial torsion, and femoral anteversion. External rotation problems are infrequent and pose fewer problems. These include calcaneovalgus, external rotation of the tibia, and external rotatory contractures of the lower extremity. The natural history of these conditions favors improvement with time. However, some patients may require conservative treatment, such as stretching and splints. Rarely, a patient may require surgical intervention.     

Rehabilitation after bilateral lower extremity amputation.

Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. In 26 of the patients bilateral below-knee amputations had been performed. Although diabetes mellitus was present in 26 of the patients, it severely hampered rehabilitation in only four. Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.     

Recurrent lower extremity pseudocellulitis

The term "Pseudocellulitis" can be used to describe an uncomplicated nonnecrotizing inflammation of the dermis and hypodermis from a noninfectious etiology. Chemotherapeutic agents have been associated with a variety of cutaneous reactions, including radiation recall dermatitis, hypersensitivity reactions, and erysipeloid reactions. Gemcitabine (2,2-difluorodeoxycytidine) is currently being used for treatment of a variety of solid malignancies, including carcinoma of the lung. The dermatitis involved with gemcitabine is typically a radiation recall reaction whereby an inflammatory reaction occurs in the area previously treated with radiotherapy. We describe here a case of Gemcitabine-induced pseudocellulitis that was unrelated to radiation exposure and manifested in an area of lymphedema. The pseudocellulitis in such cases could be related to the drug's pharmacokinetics and may last until the drug is displaced from the subcutaneous tissue of the affected area. Antibiotics have no role in the treatment, and diphenhydramine with nonsteroidal anti-inflammatories may be used for symptomatic management.     

Peripheral arterial disease of the lower extremity.

Peripheral arterial disease is becoming more prevalent due to the increasing age of the population. To better evaluate and care for patients with this disease, it is essential to understand its pathophysiology and etiology. Understanding the sequelae of events and treatments associated with peripheral arterial disease will help the nurse to provide a comprehensive, outcome-focused plan of care and education plan. Nurses are in a unique position to reduce the risks associated with lower extremity arterial disease.     

Color Doppler characteristics in normal lower extremity arteries.

The purpose of this study was to determine the normal characteristics of the lower extremity arterial system as seen with color Doppler. A total of 420 arterial segments from the level of the proximal abdominal aorta to the distal tibial and peroneal vessels were examined with a color ultrasound scanner in 10 normal volunteers. Each arterial segment was examined for the presence of triphasic flow, wall irregularities, calcification, bruits, collaterals, and post-stenotic flow patterns. Standard duplex spectral waveform data were also obtained at each site. As expected, triphasic flow was present and detected by color Doppler in the majority of arterial segments. Color patterns suggesting the presence of bruits, collaterals, or post-stenotic flow were absent in all cases.     

Percutaneous interventions for lower extremity peripheral vascular disease.

Peripheral vascular disease of the lower extremities is an important cause of morbidity that affects up to 10 million people in the United States. The primary care physician can easily identify patients who are at risk for the disease with a questionnaire and a relatively simple test-the ankle brachial index. More than 70 percent of patients diagnosed with the disease remain stable or improve with conservative management. Those who do not improve may undergo contrast angiography or magnetic resonance angiography, which may be used in planning for surgery or percutaneous intervention. Surgical bypass is the gold standard for extensive vascular occlusive disease, but endovascular interventions, including percutaneous transluminal angioplasty and stent placement, are being used more frequently, particularly in patients with significant comorbid conditions.     

A miniaturized load cell for lower extremity amputees.

The PRS-Moore Load Cell for below-knee and above-knee amputees that gives an audible warning when the wearer applies more than the predetermined weight on the affected limb is described. The sensing unit is a screw-adjustable compression spring that is enclosed in a machined housing that fits inside a machined base. Several prototypes have been produced and are now undergoing clinical analysis.     

Amputation of the lower extremity: an overview.

Amputation of the lower extremity may be traumatic or a necessary procedure to prevent further morbidity and possibly death in a patient. Advances have been made in the area of lower extremity amputation surgery and subsequent management. Prosthetic design has resulted in more lightweight, better fitting prostheses that more closely resemble the workings of a normal leg and foot. This results in a decrease in energy expenditure with walking and allows an increased activity level for amputees. This article addresses factors concerning phantom limb sensations and pain, prosthesis use and nursing considerations in rehabilitation.     

The diagnosis of lower extremity deep venous thrombosis.

The diagnosis of lower extremity deep venous thrombosis (DVT) is critical to emergency physicians because of the risk of pulmonary embolism. This article reviews the diagnostic modalities available for patients with suspected lower extremity DVT. The use of compression ultrasonography and the recent advances in the D-dimer assays are emphasized. A clinical algorithm that utilizes a non invasive approach to this potentially life threatening disease is presented.     

核素淋巴显像在下肢淋巴水肿诊断中的应用

本文对44名下肢水肿患者进行了核素淋巴显像,以探讨下肢淋巴显像的应用价值。图像按正常回流、不完全性梗阻及完全性梗阻进行分型与分析,结果表明:淋巴显像诊断下肢淋巴性水肿的灵敏度及特异性分别为88.4％及95.6％,15例患者按显像所示淋巴管梗阻部位进行了静脉一淋巴管吻合术,治疗总有效率达93.3％。研究提示核素淋巴显像不但具有安全、无创与简便的优点,而且能准确显示淋巴回流功能及梗阻部位,为治疗方法选择提供指导,具有较高的临床应用价值。     

Optokinetic nystagmus and upper extremity dressing independence after stroke

Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.