Amputation Etiology Research Articles

Assessing and Using Comorbidity Measures in Elderly Veterans with Lower Extremity Amputations

Background: Understanding comorbidity prevalence and the effects of comorbidities in older veterans with lower extremity amputations may aid in assessing patient outcomes, resource use, and facility-level quality of care. Objectives: To determine the degree to which adding outpatient to inpatient administrative data sources yields higher comorbidity prevalence estimates and improved explanatory power of models predicting 1-year mortality and to compare the Charlson/Deyo and Elixhauser comorbidity measures. Methods: A retrospective cohort study applying frequencies, cross-tabulations, and logistic regression models was conducted, including data from 2,375 veterans with lower extremity amputations. Comorbidity prevalence according to the Charlson/Deyo and Elixhauser measures, 1-year mortality rates, and standardized mortality ratios (SMRs) were analyzed. Results: Comorbidity prevalence estimates increased sharply for both the Charlson/Deyo and Elixhauser measures with the addition of data from multiple settings. The Elixhauser compared to the Charlson/Deyo generally yielded higher estimates but did not improve explanatory power for mortality. Modeling expected versus actual deaths produced varying SMRs across geographic regions but was not dependent on which measure or data sources were used. Conclusions: Merging outpatient with inpatient data may reduce the under coding of comorbidities but does not enhance mortality prediction. Compared to the Charlson/Deyo, the Elixhauser has a more complete coding scheme for comorbid conditions, such as diabetes mellitus and peripheral vascular disease, important to addressing lower extremity amputation etiology.

Preamputation Pain and Acute Pain Predict Chronic Pain After Lower Extremity Amputation

Although previous research suggests that preamputation pain is a risk factor for pain after amputation, little is known about the association between acute postsurgical pain and chronic amputation-related pain. The current prospective study examined the associations of preamputation pain and acute postamputation pain with chronic amputation-related pain. The sample consisted of patients with lower limb amputation (N = 57) who provided both preamputation and postamputation data during a 2-year study period. Preamputation pain intensity and duration were assessed before amputation; acute phantom limb pain (PLP) and residual limb pain (RLP) intensity were assessed on postsurgical days 4 and 5. Acute PLP intensity was the only significant independent predictor of chronic PLP intensity at 6 and 12 months after amputation, whereas preamputation pain intensity was the only significant predictor of chronic PLP intensity at 24 months. Similarly, acute RLP was found to be the best overall predictor of chronic RLP. Other variables (age, gender, level and etiology of amputation, amount of postsurgical pain medication, and duration of preamputation pain) were not associated with chronic pain. These results suggest that higher levels of pain either before or soon after amputation might help to identify individuals at greatest risk for chronic pain problems and most in need of early, intensive pain interventions. Perspective This study suggests that both preamputation pain and acute pain soon after amputation might be associated with bothersome chronic pain. The results support further research on acute pain mechanisms and the effectiveness of early interventions aimed at preventing or managing amputation-related pain.

Is etiology of amputation correlated with psychophysiological and psychosocial aspects of pain?

Is etiology of amputation correlated with psychophysiological and psychosocial aspects of pain?

Use and satisfaction with prosthetic limb devices and related services

Pezzin LE, Dillingham TR, MacKenzie EJ, Ephraim P, Rossbach P. Use and satisfaction with prosthetic limb devices and related services. Arch Phys Med Rehabil 2004;85:723–9. Objectives To examine the use and satisfaction with prosthetic limb devices and satisfaction with prosthetist services in a large and diverse sample of persons with limb loss. Design Retrospective cohort study. Setting General community. Participants Persons aged 18 to 84 years identified from the Amputee Coalition of America registry as having a major upper- or lower-limb loss due to vascular disease, trauma, or malignancy. Interventions Not applicable. Main Outcome Measures Use and satisfaction with prosthetic limb devices and satisfaction with prosthetists’ services, assessed via structured telephone interviews. Results Most persons (94.5%) surveyed had a prosthesis and used it extensively (71h/wk). Most persons with amputations appeared to be satisfied with the overall performance of their prostheses (75.7%). Nearly one third of them, however, expressed dissatisfaction with their prostheses’ comfort. Frequency of prosthesis use and satisfaction with the device were significantly higher among those with shorter timing to first prosthesis fitting, even after controlling for a wide array of respondents’ sociodemographic and amputation characteristics. Overall, persons with amputations in our sample had positive assessments of their prosthetists’ quality. Less favorable ratings concerned items related to the prosthetists’ interpersonal skills. Multivariate analyses showed that men and black persons with amputations were less likely than their female or white counterparts to have favorable perceptions about their prosthetists across all dimensions of provider quality. Persons with fewer years of schooling were also less likely to be satisfied with their prosthetist’s interpersonal manner. There were no significant differences in prosthesis use, satisfaction, or assessment of prosthetists’ quality based on amputation etiology or amputation level. Conclusions Efforts should be directed at minimizing the interval from surgery to first prosthesis fitting and at improving communication between patients and prosthetists, to improve the quality of care provided to the growing numbers of persons with limb loss.

Minor environmental trauma and lower extremity amputation in high-risk patients with diabetes: incidence, pivotal events, etiology, and amputation level in a prospectively followed cohort.

This study determined the incidence, pivotal events, etiology, and levels of amputation in a prospectively followed cohort of 400 people with diabetes and a prior healed foot ulcer who participated in a randomized footwear trial. Participants were seen every 17 weeks for 2 years. Subjects with foot lesions were referred to their healthcare provider for treatment. In this cohort, 11 participants required lower limb amputation (rate 13.8 per 1000 person-years). Pivotal event analysis revealed that only one amputation was related to footwear, six amputations were due to non-footwear-related minor environmental trauma, two were due to progression of vascular disease (dry gangrene from critical ischemia), one was due to a self-care injury while cutting the toenails, and one was due to a decubitus ulcer. Previously proposed strategies to reduce the amputation rates in individuals with diabetes have focused heavily on footwear and education. However, even with this emphasis, amputation rates in the United States are still high. This study suggests that the prevention of minor environmental trauma, including household accidents, merits additional attention. We believe that further efforts to reduce amputation rates for individuals with diabetes will need to emphasize the prevention of minor trauma, especially in those already compromised with neuropathy and vascular disease.

Prevalence and causal conditions for amputation surgery in the third world: ten years experience at Dodoma Regional Hospital, Tanzania.

This is a partly retrospective study of 252 major limb amputations carried out in regional hospital in Tanzania over a period of ten years mostly by the authors. The paper reports on the aetiology and levels of amputation and identifies prevalence and sex of the amputees. The causes of amputation classified under tumours, vascular diseases, trauma, infections, burns, animal bites, iatrogenic causes, maduromycosis and miscellanea--are discussed with particular reference to the influence of the environment, cultural habits and local customs.

Phantom limb pain and etiology of amputation in unilateral lower extremity amputees

The relationships between phantom limb pain and both the etiology of amputation (blood clots, nonclot diabetes, and miscellaneous) and the occurrence of gangrene and/or infection were investigated in 92 unilateral lower extremity (LE) amputees who were seen sequentially. There were 55 above-knee (AK) and 37 below-knee (BK) amputations in 61 men and 31 women. The mean age was 51.4 years. The blood-clot etiology had the highest levels of phantom pain both pre- and postrehabilitcdion, the longest time interval between amputation and prosthetic fitting; and the greatest number of medical conditions. The nonclot diabetes and miscellaneous etiologies followed in order A history of gangrene and/or infection was associated with higher levels of pain and longer time interval between amputation and prosthetic fitting.

Osseous overgrowth after amputation in adolescents and children.

We retrospectively studied the incidence of primary surgical revision for stump overgrowth in a population of childhood and adolescent amputees. The anatomic location and the etiology of amputation are critical to the occurrence of overgrowth needing revision. Metaphyseal-level amputations are the most likely to develop overgrowth requiring revision (50%), whereas diaphyseal amputations are slightly less likely (45%). Joint disarticulations never develop overgrowth. Traumatic amputations are the most frequent mode of injury requiring revision of overgrowth (43%), followed by congenital or intrauterine amputations (30%) and elective amputations (20%). Radiographic classification of the osseous overgrowth helps define its severity and degree of ossific progression. Surgical revisions are usually performed when overgrowth reaches a grade 3 classification. The majority of skeletally immature diaphyseal- or metaphyseal-level amputees, including those with certain preexisting orthopaedic conditions, retain the ability to develop osseous overgrowth at the apex of the stump skeleton.

Osseous Overgrowth After Amputation in Adolescents and Children

Summary We retrospectively studied the incidence of primary surgical revision for stump overgrowth in a population of childhood and adolescent amputees. The anatomic location and the etiology of amputation are critical to the occurrence of overgrowth needing revision. Metaphyseal-level amputations are the most likely to develop overgrowth requiring revision (50%), whereas diaphyseal amputations are slightly less likely (45%). Joint disarticulations never develop overgrowth. Traumatic amputations are the most frequent mode of injury requiring revision of overgrowth (43%), followed by congenital or intrauterine amputations (30%) and elective amputations (20%). Radiographic classification of the osseous overgrowth helps define its severity and degree of ossific progression. Surgical revisions are usually performed when overgrowth reaches a grade 3 classification. The majority of skeletally immature diaphyseal- or metaphyseal-level amputees, including those with certain preexisting orthopaedic conditions, retain the ability to develop osseous overgrowth at the apex of the stump skeleton.

Rehabilitation of amputees with end-stage renal disease. Functional outcome and cost.

A retrospective chart review was performed on 19 lower extremity amputees with end-stage renal disease (ESRD) on dialysis and 19 controls with peripheral vascular disease (PVD) without ESRD to compare functional outcome with costs of rehabilitation. The groups were similar demographically and by etiology, level and side of amputation. Functional outcome as measured by Functional Independence Measure (FIM) scores did not show a significant difference between the groups on admission (P = 0.19), discharge (P = 0.20) or change in FIM (P = 0.94). The percentage of successful prosthetic ambulators (P = 0.74) and the duration of prosthetic training (P = 0.60) were not statistically different between the groups. Cost as measured by total hospital length of stay (LOS) was not significantly different (P = 0.43), but the renal group showed a significantly longer acute hospital LOS (P = 0.02) and a trend for a shorter rehabilitation LOS (P = 0.08). Mortality, discharge setting and home care arrangements on discharge were similar for the groups. The renal group had a significantly greater number of co-morbidities than the non-renal group (P = 0.002). Despite the large number of medical problems, amputees on renal dialysis admitted to acute rehabilitation had similar outcomes with similar costs to amputees with PVD without renal failure.

Rehabilitation of persons with bilateral amputation of lower extremities.

The effectiveness of a program of rehabilitation was studied in 50 patients with bilateral amputation of lower extremities. The average age was 55 years, and the reason for amputation was peripheral vascular disease in 34 cases. The rehabilitation program included preprosthetic training, instructions in activities of daily living, prevocational evaluation and guidance, and job placement when indicated. Failures were explained only in part by the presence of severe medical complications. Age, primary etiology, and site of amputation were found, by systematic analysis, to have no direct bearing on the likelihood that a given patient would become self-sufficient. Motivation appeared to be a contributing factor. Thirty-five patients were considered rehabilitated, and 16 of these became economically independent.

The Structure of the Vertebrate Eye as an Index of Developmental Deficiencies: With the Bearing on Recent Inheritance Studies

Previous articleNext article FreeThe Structure of the Vertebrate Eye as an Index of Developmental Deficiencies: With the Bearing on Recent Inheritance StudiesCharles R. StockardCharles R. Stockard Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by The American Naturalist Volume 58, Number 654Jan. - Feb., 1924 Published for The American Society of Naturalists Article DOIhttps://doi.org/10.1086/279952 Views: 21Total views on this site Citations: 7Citations are reported from Crossref PDF download Crossref reports the following articles citing this article:Vergil H. Ferm Effect of transplacental mitotic inhibitors on the fetal hamster eye, The Anatomical Record 148, no.22 (Feb 1964): 129–137.https://doi.org/10.1002/ar.1091480203R. Brückner Spaltlampenmikroskopie und Ophthalmoskopie am Auge von Ratte und Maus, Documenta Ophthalmologica 5-6, no.11 (Jan 1951): 452–554.https://doi.org/10.1007/BF00143667Peter Gruenwald Studies on developmental pathology. II. Sporadic unilateral microphthalmia and associated malformations in chick embryos, American Journal of Anatomy 74, no.22 (Mar 1944): 217–257.https://doi.org/10.1002/aja.1000740204Thesle T. Job, George J. Leibold, H. A. Fitzmaurice Biological effects of roentgen rays. The determination of critical periods in mammalian development with x-rays, American Journal of Anatomy 56, no.11 (Jan 1935): 97–117.https://doi.org/10.1002/aja.1000560106Halsey J. Bagg Hereditary abnormalities of the limbs, their origin and transmission. II. A morphological study with special reference to the etiology of club-feet, syndactylism, hypodactylism, and congenital amputation in the descendants of x-rayed mice, American Journal of Anatomy 43, no.22 (Mar 1929): 167–219.https://doi.org/10.1002/aja.1000430203Marie A. Hinrichs Modification of development on the basis of differential susceptibility to radiation I. Fundulus heteroclitus and ultraviolet radiation, Journal of Morphology 41, no.11 (Dec 1925): 239–265.https://doi.org/10.1002/jmor.1050410111Halsey J. Bagg Hereditary abnormalities of the viscera. I. A morphological study with special reference to abnormalities of the kidneys in the descendants of x-rayed mice, American Journal of Anatomy 36, no.22 (Nov 1925): 275–311.https://doi.org/10.1002/aja.1000360205