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Extremity Trauma
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The management of the mangled limb remains a vexing problem, should be multidisciplinary, and involve the combined skills of the orthopaedic, vascular, plastic, and reconstructive surgeons, as well as the rehabilitation specialist. Poorly coordinated management often results in more complications, increased duration of treatment, and a less favourable outcome for the patient. Ultimately, the decision to amputate or repair is often a difficult one, and best shared, if possible, with a senior colleague. The cost of rehabilitation is often less – and the time shorter – if a primary amputation is performed, than if lengthy and repeated operations are undertaken, and persistent painful debility or an insensate or flail limb is still the outcome. A successful limb salvage is defined by the overall function and satisfaction of the patient.
The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study
Published in Disability and Rehabilitation, 2021
Sara Brito, Jennifer White, Nikos Thomacos, Bridget Hill
All participants perceived their surgery as being beneficial despite the experience of on-going functional limitations and concerns about the future. Participants recognized that their impaired arm was a helper arm and would not return to pre-injury ability. However participants noted that even small gains in ability were better than a flail limb and all participants felt that some arm use was better than no use.Now I can position it…[But] I hardly use it at all. DanielWith my arm, I accept that it's - I've got a bum arm, but it's pretty much is a helping hand. Even if the only thing I can do is open and close doors, that's awesome. That helps a lot” Mason
Elevated plasma levels of D-serine in some patients with amyotrophic lateral sclerosis
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Aven Lee, Buddhika Jayakody Arachchige, Robert Henderson, David Pow, Sarah Reed, James Aylward, Pamela Ann McCombe
We recruited 30 ALS patients from the Motor Neuron Disease clinic at the Royal Brisbane & Women's Hospital. Healthy controls (n = 30), who were caregivers of the ALS patients were also recruited. All patients with a diagnosis are invited to participate, with no selection or entry criteria. At entry, all ALS patients had a diagnosis of clinically definite or clinically probable ALS according to the revised El Escorial criteria. By the end of the study, 26 patients had clinically definite ALS (14 patients had died of ALS and 12 were alive with clinically definite ALS). Of the remainder, three were alive with upper motor neurone predominant disease and one was alive with flail limb phenotype. We recorded the age of onset, duration of disease from the time of onset of symptoms to the time of blood collection and site of onset. The burden of disease at the time of blood collection was measured as the ALSFRS-R. We noted whether disease was sporadic or familial and the genotype if this was known but there was no systemic genetic screening for ALS causative genes.
Motor Neuron Disease Register for England, Wales and Northern Ireland—an analysis of incidence in England
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Sarah Opie-Martin, Lynn Ossher, Andrea Bredin, Anna Kulka, Neil Pearce, Kevin Talbot, Ammar Al-Chalabi
Eligible individuals were defined as having been diagnosed with ALS, Primary Lateral Sclerosis (PLS), or Progressive Muscular Atrophy (PMA) by a consultant neurologist. Where motor neuron involvement appeared to be restricted to the upper or lower motor neurons (including flail limb variants), but time since diagnosis was less than 4 years, the diagnostic category was recorded as “upper motor neuron predominant ALS” or “lower motor neuron predominant ALS”, with a free text box available for provision of more detail if needed. Site of onset of first focal weakness, El Escorial category, and co-existing dementia were considered as phenotypic modifiers and recorded as separate variables (26). People with cognitive impairment, including those with fronto-temporal dementia were eligible. People with Kennedy’s disease were not included.