Proximal major limb amputations – a retrospective analysis of 45 oncological cases

<p>Abstract</p> <p>Background</p> <p>Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage.</p> <p>Methods</p> <p>Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14), shoulder disarticulation (n = 13), hemipelvectomy (n = 3) or hip disarticulation (n = 15) were included.</p> <p>Results</p> <p>The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597). Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly.</p> <p>Conclusion</p> <p>Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.</p

Doom and Boom on a Resilient Reef: Climate Change, Algal Overgrowth and Coral Recovery

Background: Coral reefs around the world are experiencing large-scale degradation, largely due to global climate change, overfishing, diseases and eutrophication. Climate change models suggest increasing frequency and severity of warming-induced coral bleaching events, with consequent increases in coral mortality and algal overgrowth. Critically, the recovery of damaged reefs will depend on the reversibility of seaweed blooms, generally considered to depend on grazing of the seaweed, and replenishment of corals by larvae that successfully recruit to damaged reefs. These processes usually take years to decades to bring a reef back to coral dominance

Local processes strongly influence post-bleaching benthic recovery in the Lakshadweep Islands

The atoll reefs of the Lakshadweep, in the Indian Ocean suffered a catastrophic mortality of hard coral in the wake of the El Niño event of 1998. This study tracked changes to coral and other benthic elements in three atolls in the Lakshadweep from 2000 to 2003. The recovery of coral was highly site-specific, and appeared to be driven by differences in post-settlement survival of coral recruits, that were in turn, influenced by the local hydrodynamics of the atolls. Post bleaching recovery was highest on west-facing reefs, while recovery on east-facing reefs was very limited. However, no ‘phase-shift’ to macroalgal dominated reefs was evident. High herbivore pressures were perhaps the most important control of macroalgae. Five years after the mass mortality, the genera that showed the maximum gains represented a mix of different susceptibilities to bleaching, while some genera that were not particularly susceptible to bleaching showed significant declines. These results suggest that decline or recovery of coral is likely dependent on individual life history strategies, post-recruitment survival, and contingency