Proximal Humeral Reconstruction Using Nail Cement Spacer in Primary and Metastatic Tumours of Proximal Humerus.

Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus.

Strategies Trauma Limb Reconstr. 2013 Aug 8;
Kundu ZS, Gogna P, Gupta V, Kamboj P, Singla R, Sangwan SS

Limb salvage surgery for malignant tumours of proximal humerus is an operative challenge, where the surgeon has to preserve elbow and hand functions and retain shoulder stability with as much function as possible. We treated 14 consecutive patients with primary malignant or isolated metastasis of proximal humerus with surgical resection and reconstruction by nail cement spacer. There were 8 females and 6 males, with a mean age of 28.92 years (range 16-51 years) and a mean follow-up of 30.14 months (range 12-52 months). The diagnosis was osteosarcoma in 8 patients, chondrosarcoma in 4 patients and metastasis from thyroid and breast carcinoma in 1 patient each. One of our patients had radial nerve neuropraxia, 1 developed inferior subluxation and 3 developed distant metastasis. Two patients died of disease and one developed local recurrence leading to forequarter amputation, leaving a total of 11 patients with functional extremities for assessment at the time of final follow-up which was done using the Musculoskeletal Tumour Society (MSTS) score. Though we were able to preserve the elbow, wrist and hand functions in all patients, the abductor mechanism, deltoid muscle and axillary nerve were not salvageable in any of cases. The mean MSTS score at the time of final follow-up was 19.09. Thus, proximal humeral reconstruction using nail cement spacer is a technical simple, cost-effective and reproducible procedure which makes it a reliable option in subset of patients where the functions around the shoulder cannot be preserved despite costlier prosthesis. HubMed – rehab

Determinants of inpatient rehabilitation length of stay and discharge modality after hip and knee replacement surgery in Switzerland – a retrospective observational study.

Swiss Med Wkly. 2013; 143: w13832
Tal-Akabi A, Schmid S, Taeymans J

The aims of this study were to identify the determinants influencing the inpatient rehabilitation length of stay (LoS) and discharge modality (DisMod) after hip or knee replacement surgery.Data were retrieved for 306 patients (185 females, 121 males) who were admitted to a Swiss orthopaedic rehabilitation facility between 2007 and 2008 after hip or knee replacement surgery. LoS and DisMod were extracted from the medical files along with an additional seven binary and six continuous variables (including scores of timed-get-up-and-go [TUG], walking distance [WDT] and stair climbing tests [FIM_St]). Nonparametric procedures were used to detect differences between the gender groups. For the analysis of the LoS determinants, a linear regression model was used. The nonmotor performance test determinants of DisMod were analysed using a logistic regression model, whereas the motor performance test determinants were examined using binary classification. For both regression models, a backward procedure was used.Unlike DisMod, LoS calculations were conducted after stratification for gender. The simplified regression models explained 22% (females) and 31% (males) of the LoS variance and 20% (both genders) of the DisMod variance. TUG, WDT and FIM_St were all important predictors for LoS, whereas DisMod could be best predicted by WDT.Patients with good motor ability at admission were discharged earlier and more frequently to home. These findings might be of importance for preoperative physiotherapeutic care and might help to improve care planning as well as more accurately predict the access to inpatients beds and the allocation of resources. HubMed – rehab

Cocoa, neurovascular coupling, and neurodegeneration: The good, the bad, and the ugly.

Neurology. 2013 Aug 7;
Rosenberg PB, Tan CO

Though the human brain is only ?2% of body mass, it represents more than 20% of total body oxygen and energy consumption,(1,2) and the supply of blood to the active neurons must match their metabolic demand. Fortunately, the tight coupling between capillary endothelial cells, astrocytes, pericytes, and neurons-dubbed the neurovascular unit-ensures precise modulation of regional blood flow in response to local metabolic demand. This integration of supply and demand, termed neurovascular coupling (NVC), is critical to neurophysiologic health. Indeed, accumulating evidence shows an important role for cerebral vascular insufficiency in neurodegenerative diseases ranging from vascular cognitive impairment(3) to Alzheimer disease.(4) Therefore, targeting cerebral vascular pathology is a promising option for primary and secondary prevention of neurodegenerative diseases and subsequent cognitive impairments. HubMed – rehab

Developing Community Support for Homeless People with Mental Illness in Transition.

Community Ment Health J. 2013 Aug 8;
Chen FP

To facilitate effective transitional services and enhance continuity of care among people with mental illness, this grounded theory study explored the practice of developing community support in critical time intervention (CTI), a time-limited, shortterm psychosocial rehabilitation program designed to facilitate the critical transition from institutional to community settings. Semi-structured, one-on-one interviews with twelve CTI workers were analyzed. Results show that CTI workers self-identified as an “extra support” to develop community ties that will help clients sustain stable housing. Their practice of community support development was represented by a transient triangular relationship model, involving three dyadic relationships (worker-client, worker-primary support, primary support-client) as the building blocks and specific strategies to facilitate the relational transition. Findings also detailed identification of community supports, collaboration and boundary issues in working with primary supports, and engagement with clients in this transitional process. Recommendations were drawn from findings to enhance broad discharge and transitional services. HubMed – rehab

Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: a randomized controlled trial.

Breast Cancer. 2013 Aug 8;
Uzkeser H, Karatay S, Erdemci B, Koc M, Senel K

This study has two aims. The first was to investigate the efficacy and contribution of an intermittent pneumatic compression pump in the management of lymphedema, and the second was to evaluate the correlation of our measurement methods.This study was designed as a controlled clinical trial at the Physical Medicine and Rehabilitation Department of Ataturk University Faculty of Medicine. Thirty-one patients with upper extremity lymphedema following mastectomy participated in the study. The patients were divided into two groups. The complex decongestive physical therapy (CDT) group (group 1, n = 15) received allocated treatment, including skin care, manual lymphatic drainage, compression bandages, compression garments, and exercises. The other group had CDT combined with an intermittent pneumatic compression pump (group 2, n = 16). Both groups were treated five times a week for 3 weeks (for a total of 15 sessions). Patients were assessed according to circumference measurements of landmarks, limb volume difference, dermal thickness with ultrasonography (USG), and pain.We observed significant differencse in both groups when comparing them before and after therapy. The baseline median volume difference of group 1 was 630 (180-1,820), and after therapy it was 480 (0-1,410). In group 2, the beginning median volume difference was 840 (220-3,460), and after therapy it was 500 (60-2,160). However, no significant differences were observed between the two groups in terms of the above-mentioned parameters.We concluded that the pneumatic compression pump did not contribute to the reduction of lymphedema. In addition, gauging dermal thickness using USG may prove to be a useful measurement method in the evaluation of lymphedema. HubMed – rehab

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