Changes in the activities of daily living (ADL) in relation to the level of amputation of patients undergoing lower extremity amputation for arteriosclerosis obliterans (ASO).

BACKGROUND: The relationship between the level of amputation and the activities of daily living (ADL) in Japanese patients with arteriosclerosis obliterans (ASO) is unclear. METHODS AND RESULTS: In the present study 81 patients with ASO who underwent lower extremity amputation and were discharged from hospital after rehabilitation we evaluated. The patients were classified into 4 groups: toe amputation group (Toe), heel-preserving amputation group (Heel), below-knee amputation group (BK), and above-knee amputation group (AK). ADL at discharge and factors affecting the length of hospitalization were determined. Patients were walking at discharge in 94.5%, 94.0%, 59.0%, and 0.0% of the Toe, the Heel, BK, and AK group, respectively. However, the ratio of patients able to walk independently was 68% in the Toe group and 19% in the Heel group. In addition, the length of hospital stay was significant shorter in the Toe group than in the other groups. Factors affecting the length of hospital stay were the amputation level, cerebrovascular disease, reoperation, and diabetes. CONCLUSIONS: ADL are less affected and the length of hospital stay is shorter for patients undergoing toe amputation than other levels of lower extremity amputation. However, heel-preserving amputation maintains a comparable level of ADL in terms of ambulatory discharge.

Validity and reliability of craniofacial anthropometric measurement of 3D digital photogrammetric images.

BACKGROUND: Direct anthropometry performed during a patient examination is the standard technique for quantifying craniofacial dysmorphology, as well as for surgical planning and outcome assessment. Several new technologies have been designed to computerize anthropometric measurements, including three-dimensional (3D) digital photogrammetry. These digital systems have the advantage of acquiring patient craniofacial surface images quickly and noninvasively. Before morphometry using digital photogrammetry can be applied in clinical and research practice, it must be assessed against direct anthropometry. OBJECTIVE: To evaluate the validity and reliability of facial anthropometric linear distances imaged by 3D digital photogrammetry with respect to direct anthropometry. DESIGN, SETTING, PARTICIPANTS, MEASURES: Standard craniofacial distances were directly measured twice on 20 normal adult volunteers. Craniofacial surfaces were also imaged using the 3dMDface digital photogrammetry system, and distances were digitally measured twice for each subject. Validity measures of accuracy and bias (for direct versus digital measurements) and reproducibility measures of precision and test-retest reliability (for repeated sets of digital measurements) were computed. RESULTS: Seventeen of the 18 direct measurements correlated highly with digital values (mean r = 0.88). The correlation for one measurement (upper prolabial width) was not statistically significant. The overall precision of all 17 digital measurements was less than 1 mm, and the reliability was high (mean r = 0.91). CONCLUSIONS: Craniofacial anthropometry using the 3dMDface System is valid and reliable. Digital measurements of upper prolabial width may require direct marking, prior to imaging, to improve landmark identification.

Facial asymmetry in unilateral coronal synostosis: long-term results after fronto-orbital advancement.

BACKGROUND: Unilateral coronal synostosis causes asymmetry of the forehead and face. The authors set out to document asymmetry and rotation of the middle/lower facial soft tissues using three-dimensional photogrammetry in adolescent and adult patients with unilateral coronal synostosis who underwent correction in infancy. METHODS: All patients older than 10 years who had bilateral fronto-orbital advancement in infancy for nonsyndromic unilateral coronal synostosis were eligible for this study. The following paired anthropometric distances were measured: medial canthus to facial midline distance (endocanthion to sellion); middle facial depth (tragion to subnasale); and lower facial depth (tragion to gnathion). Nasal tip deviation (sellion to pronasale) and facial midline deviation (sellion to subnasale to gnathion) were also measured. RESULTS: There were 15 patients with an average age at fronto-orbital advancement of 8 months (range, 3 to 14 months). Three-dimensional digital images were taken at an average age of 14 years (range, 11 to 29 years). Digital anthropometry documented decreased mean middle facial depth (5.1 +/- 3.2 mm; p < 0.00001) and lower facial depth (2.7 +/- 2.5 mm; p < 0.00001) on the fused side. Average deviation of the nasal tip and facial midline to the nonfused side was 5.0 +/- 1.2 degrees and 3.4 +/- 0.7 degrees, respectively. All 15 patients exhibited rotation of the middle and lower face to the nonfused side (chi-square analysis, p < 0.0001). Applying the Bonferroni correction, asymmetry did not correlate with age at frontal advancement or age at digital imaging. CONCLUSION: Adolescents and adults with unilateral coronal synostosis who underwent fronto-orbital advancement in infancy have consistent middle and lower facial asymmetry.

Quality of life improvement and long-term effects of peripheral blood mononuclear cell transplantation for severe arteriosclerosis obliterans in diabetic patients on dialysis.

BACKGROUND: Severe arteriosclerosis obliterans (ASO) can be intractable, especially in diabetic patients on hemodialysis (HD). Recently, the transplantation of autologous peripheral blood mononuclear cells (PBMNCs) has been reported to have beneficial effects, but the long-term effects and impact on quality of life (QOL) have not been studied. METHODS AND RESULTS: Autologous PBMNCs were transplanted into 7 diabetic patients on HD who had severe ASO (5 cases with Fontaine IV and 2 with Fontaine III) after administration of 5 microg/kg granulocyte colony stimulating factor; QOL and degree of ischemia was assessed by measuring skin temperature, skin perfusion pressure (SPP), ankle-brachial index (ABI), and ulcer size, and from angiographic findings. At 4 weeks after the procedure, skin temperature was significantly improved, and SPP and ABI also were increased. These beneficial effects persisted for up to 24 weeks. Angiographic findings and ulcer size improved in 3 of 7 and 3 of 4 patients, respectively. SF-36v2 analysis revealed significant improvements in pain scores. No serious complications were detected. CONCLUSION: Transplantation of PBMNCs resulted in improvement in pain and leg ischemia for over 6 months without serious complications. This therapy is safe and effective for severe ASO in diabetic patients on HD.