ABSTRACT
Most surgeons believe that incorporation of a pneumatic thigh tourniquet requires concomitant use of general anesthesia to prevent the patient from experiencing intolerable discomfort. These authors explored use of pneumatic thigh tourniquets in combination with local standby sedation by conducting a two-part study. A group of nonsedated student volunteers was first studied, after applying pneumatic thigh tourniquets. They expressed an average time to pain tolerance of 31.5 min. This was followed by a study of sedated patients in the operating room, where the average time to pain tolerance was 45.3 min. The manuscript further characterized the thigh tourniquet pain experience. Guidelines are discussed to maximize the patient's pain tolerance, while maintaining effective hemostasis throughout the surgical procedure.
Subject(s)
Anesthesia , Foot/surgery , Hemostasis, Surgical , Tourniquets , Humans , Pain Measurement , Time Factors , Tourniquets/adverse effectsABSTRACT
Soft tissue malignancies represent a diagnostic and therapeutic challenge to the podiatric physician. In order to improve prognosis and increase survival rates of affected patients, prompt clinical and histologic recognition of suspect lesions is necessary. Here we present information and case reports on selected soft tissue malignancies including Kaposi's sarcoma, malignant melanoma, synovial sarcoma, and epithelioid sarcoma to aid the practitioner in recognizing these serious lesions that occur in the foot.
Subject(s)
Foot Diseases , Soft Tissue Neoplasms , Acquired Immunodeficiency Syndrome/complications , Adult , Aged , Child , Child, Preschool , Diagnosis, Differential , Female , Homosexuality , Humans , Infant , Male , Melanoma/diagnosis , Melanoma/pathology , Melanoma/therapy , Middle Aged , Sarcoma/diagnosis , Sarcoma/pathology , Sarcoma/therapy , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/pathology , Sarcoma, Kaposi/therapy , Sarcoma, Synovial/diagnosis , Sarcoma, Synovial/pathology , Sarcoma, Synovial/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/therapyABSTRACT
Osteochondroma represents the most common benign bone tumor and occurs most frequently in the proximal humerus, tibia, and distal femur. The bones of the foot, by comparison, are less commonly involved. The tumor appears to be a developmental defect of bone preformed in cartilage rather than a true neoplasm. However, on rare occasions it may undergo chondrosarcomatous degeneration, thus demonstrating neoplastic behavior. A review of the literature, including clinical features of osteochondroma, radiologic and histologic characteristics, and theories on pathogenesis, is presented. Information concerning principles of surgical treatment, techniques of diagnosis, and facts to aid in the differential diagnosis of osteochondroma is presented also. Finally, a series of case reports is presented to demonstrate the surgical treatment of osteochondroma of the foot. Included are three cases of phalangeal osteochondroma, one of metatarsal osteochondroma, and an unusual report of osteochondroma of the talus. A case report and discussion of a patient with juxtacortical circumscripta myositis ossificans of the foot is also presented to demonstrate how information on lesions included in the differential of osteochondroma can be utilized clinically to make the diagnosis.
Subject(s)
Bone Neoplasms/diagnosis , Chondroma/diagnosis , Foot Diseases/diagnosis , Adult , Age Factors , Aged , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Bone and Bones/diagnostic imaging , Cartilage/pathology , Chondroma/pathology , Chondroma/surgery , Diagnosis, Differential , Female , Foot Diseases/pathology , Foot Diseases/surgery , Humans , Male , Radionuclide Imaging , Tomography, X-Ray Computed , XeroradiographyABSTRACT
Photoproducts formed in the DNA of human cells irradiated with ultraviolet light (uv) were identified as cyclobuytl pyrimidine dimers by their chromatographic mobility, reversibility to monomers upon short wavelength uv irradiation, and comparison of the kinetics of this monomerization with that of authentic cis-syn thymine-thymine dimers prepared by irradiation of thymine in ice. The level of cellular photoreactivation of these dimers reflects the level of photoreactivating enzyme measured in cell extracts. Action spectra for cellular dimer photoreactivation in the xeroderma pigmentosum line XP12BE agree in range (300 nm to at least 577 nm) and maximum (near 400 nm) with that for photoreactivation by purified human photoreactivating enzyme. Normal human cells can also photoreactivate dimers in their DNA. The action spectrum for the cellular monomerization of dimers is similar to that for photoreactivation by the photoreactivating enzyme in extracts of normal human fibroblasts.
