What could be the cause of the amputation?

B) In sub-stage 3B, the pain is always persistent. It is impossible to keep your legs level for more than 2 hours. There is swelling due to lower limb ischemia (poor circulation).

Why can a leg be amputated?

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MedTravel International Medical Treatment 'Treatment in Germany' Indications for amputations - treatment in Germany

INDICATIONS FOR AMPUTATIONS – TREATMENT IN GERMANY

Indications and contraindications for amputation

In any situation, doctors do whatever they can to save the patient's injured arm or leg. However, there are critical cases when only amputation can save a person's life or preserve a large part of the limb. Physicians have a special responsibility in deciding whether amputation/exhumation is necessary and advisable, with a team of specialists deciding the necessity and desirability of such a major step. The consent of the patient or his relatives must be obtained.

There are two groups of indications for amputation/disarticulation:

These include irreversible processes and failure of conservative treatments to maintain hand/foot integrity. This also includes traumatic lacerations of the limbs and developed soft tissue gangrene. The latter can result from burns, frostbite, electrical trauma, anaerobic endarteritis, embolism, or diabetic angiopathy.

The absolute indication for amputation is the triad of two-thirds damage to the soft tissues of the limb, damage and/or crushing of the large neurovascular bundles, and bone damage.

In this case, the amputation/disarticulation will be considered on a case-by-case basis, taking into account the individual patient's condition. Surgery is performed only when the limb injury or disease is immediately life-threatening. These include an acute wound infection of the gasphlegm type, caused by Clostridium difficile or various other pathogens, which is accompanied by intoxication, which significantly worsens the patient's condition, up to a real risk of death. With the advent of the antibiotic age and the introduction of various antimicrobial drugs, as well as specific sera and oxygen therapy, the number of amputations performed for this reason has decreased significantly.

What is atherosclerosis?

Atherosclerosis is a disease characterized by metabolic disorders. In patients with this disease, disorders of lipid metabolism predominate. As a result, the ratio of 'good' and 'bad' cholesterol and other lipids is altered. This leads to changes in the arterial walls due to the formation of fatty deposits. As these enlarge, the inner lumen of the vessels narrows. This leads to a poor blood supply to organs and tissues - they receive only few nutrients and less oxygen. As a result, hypoxia occurs, organs begin to fail, and cell necrosis (death) may occur.

The main cause of atherosclerosis in the arteries of the lower limbs is a disruption in lipid metabolism. It leads to the formation of fatty deposits on the walls of blood vessels. Artery walls become saturated with fat and lose their elasticity. Large deposits that narrow the lumen of blood vessels are called atherosclerotic plaques.

Atherosclerosis in the leg arteries is often accompanied by obliteration – the lumen of the vessel is closed by connective tissue that is blocked by calcium deposits. This reduces blood flow to the knees, lower legs, and feet. Your cells lack oxygen and nutrients. With a critical lack of oxygen and the development of thrombosis, obliterative atherosclerosis can develop into gangrene.

risk factors

The causes of atherosclerosis are not exactly known. However, there are risk factors, that is, features or conditions of the body that increase the likelihood of developing atherosclerosis in the legs. These factors are immutable, meaning they cannot be influenced, and modifiable, meaning they can be eliminated.

• age (the risk of atherosclerosis increases with age);
• gender (the disease is more common in men);
• Heredity (atherosclerotic artery disease is more common in people whose close relatives have had cardiovascular disease).

• Smoking;
• Obesity;
• unbalanced diet;
• sedentary lifestyle;
• kidney failure;
• High blood pressure;
• Diabetes.

The various pathologies are classified as modifiable risk factors because they can be treated. Even symptomatic treatment of the symptoms, and not the cause of the disease, significantly reduces the risk of developing vascular atherosclerosis in the legs.

Why does gangrene develop: risk factors

Loss of blood supply and infection are the main causes of gangrene of the limbs and organs. Ischemia can result not only from compression or frostbite. Surgery and injuries that damage the skin can also lead to necrosis, especially in patients who already have a disease that affects blood flow.

• Older age. Elderly people are more prone to developing circulatory disorders than younger people due to the natural wear and tear of blood vessels, and the elderly often suffer from atherosclerosis or thrombosis.
• immunosuppression. In immunocompromised patients, the body is less able to fight off infections. If germs actively multiply, this can lead to necrosis even without injury.
• Diabetes. Patients have damaged blood vessels due to the increased glucose levels. The sensitivity of the nerve endings is also impaired, so this group of patients should be monitored particularly carefully for skin changes.
• overweight. In obese people, the organs and blood vessels are overly compressed.

People at risk should regularly check their skin for wounds, ulcers, swelling, redness, pallor and numbness. Cuts must be treated with antiseptics because they heal slowly and the risk of infection is high.

types of gangrene

The prognosis largely depends on the type of necrosis. With the dry form, it is enough to remove the necrotic tissue, but with extensive necrosis, amputation of part of the leg or the entire limb is required. This can only be avoided with immediate medical attention. Even homemade compresses cannot prevent the necrosis from spreading. The most dangerous is infection, since the inflammatory process spreads to the surrounding organs.

Causes of dry gangrene

With this form, the tissue shrinks and dries out like a mummy. The skin is usually blackened or brown, but it can also be purplish or blue in color. Most often this form develops slowly and mostly in patients with vascular diseases. The boundary between diseased and healthy tissue is usually clear, since the foci of necrosis are isolated from intact areas.

Causes of wet gangrene

This form occurs when there is an infection. The skin appears shiny rather than dry. Blisters are visible in the skin and the limb swells. It is difficult to see a clear demarcation between necrosis and healthy tissue. Diabetics are particularly susceptible to this form: bacteria can penetrate any wound and multiply quickly. People with burns, severe injuries or frostbite are at risk.

Causes of gas gangrene

With deep muscle injuries, the skin may appear normal on the surface. Over time, bacteria begin to release toxins that form gases. When pressed, a crackling sound and the smell of decomposition can be heard. This type of disease can develop after surgery or severe trauma in oxygen-deprived areas. The disease develops rapidly and can take the life of the patient.

The causes of leg cancer are:

• heredity;
• bad ecology;
• work with chemicals;
• unhealthy lifestyle; ingestion of pollutants;
• bone injuries and fractures;
• High level of radiation;
• Chronic diseases, including bone diseases;
• Consequences of bone marrow transplants;
• metastases from other organs;
• Paget's disease.

At first, the disease does not make itself felt in any way. Then the first symptoms appear: malaise, fatigue, loss of ability to work, fever, loss of appetite and weight loss.

In the second and third stages, pain syndrome occurs.

In the later stages, the soft tissues are already swollen and the joints lose their mobility. The fever rises and the skin becomes thin. Claudication and fractures of the lower limbs occur.

diagnosis

The doctor must first examine the suspected swollen leg, observe the symptoms of the condition, and examine the soft tissues for swelling.

The doctor will then recommend the following tests:

blood tests

X-ray examination

One of the main methods of diagnosing leg cancer. She can show the tumor itself, its shape and size, its location and assess the condition of the bone structures.

MRI, CT (magnetic resonance imaging, computed tomography)

These examinations make it possible to visualize the tumor layer by layer and to determine its shape, location and size.

biopsy

With this technique, a small piece of tumor tissue is removed and then sent for histological examination. An open biopsy is performed under general anesthesia by removing tumor cells through an incision. A closed biopsy, on the other hand, is performed through a puncture under local anesthesia.

About the pathology

Regular erectile dysfunction associated with the inability to have normal sexual intercourse is called erectile dysfunction. One speaks of impotence when the penis does not reach sufficient hardness during sexual arousal so that a man cannot have penetrative sexual intercourse. Impotence is understood to mean both the absence of an erection and the spontaneous relaxation of the tension in the organ.

Many patients are wondering: when does male impotence appear? The answer to this question is not clear. According to statistics, about 50 percent of men over the age of 40 suffer from erectile dysfunction. However, organic and psychosomatic impotence can appear earlier (at the age of 20-30 years).

The development of this pathology is influenced by the work of other organs and systems and the general state of health of the body. Dysfunctions can be caused by chronic diseases, infectious diseases or pain syndromes. With age, when testosterone production decreases, sex drive decreases, which also affects the quantity and quality of erections.

If the condition is monitored, timely examination and necessary treatment are carried out, and a regular sex life with a permanent partner is maintained, it is possible to remain sexually active into old age.

Symptoms of organic dysfunction

How impotence manifests itself depends on the cause of the disease. Medical professionals distinguish between two types of disorders: organic and psychogenic. The first type is related to disorders in the systems that ensure the act of erection. It can occur as a result of cardiovascular pathologies, chronic diseases, innervation disorders, inflammatory processes and endocrine pathologies.

With an organic lesion, the following symptoms are observed:

• absence or reduced quality of erection during intercourse (the problem is chronic, occurs gradually and slowly builds);
• lack of spontaneous erection in the morning and at night;
• Shortened duration of coitus;
• Premature ejaculation;
• failure to get an erection with masturbation and other types of stimulation;
• failure to ejaculate or being unable to complete it;
• Decreased sensitivity of orgasms.

As a rule, the pathological processes leading to organic impotence cause an occasional fiasco in the initial stages. Thereafter, in the absence of appropriate therapy, the symptoms worsen.

The treatment of pathology consists in identifying and eliminating the cause. As the physiological aspect of the process, ie the disrupted blood supply to the corpus cavernosum, suffers, it is the doctor's job to determine the triggering mechanism. The most common causes of sexual impotence are as follows:

Causes of lesions in the legs

How does alcoholic polyneuropathy develop? It is caused by a disruption in the sheaths of the fibers that innervate the structures of the lower limbs. When the envelope is absent, impulse transmission through the neuron is reduced by a factor of 5-24.

The direct causes of alcoholic polyneuropathy of the lower limbs are:

• Damage to nerve fibers by ethyl alcohol and its metabolite acetaldehyde;
• insufficient blood supply to the neurons. lack of oxygen, proteins, fats, carbohydrates, minerals and vitamins;

• Vitamin B1 deficiency in alcoholics. This in turn is caused by malnutrition (alcoholics often belong to socially disadvantaged groups), digestive disorders and liver damage that can occur in alcohol dependents;
• compression of nerve fibers due to the fact that the alcoholic often sleeps in unnatural positions. If it lasts longer (more than 1 hour), the blood supply to the nerve tissue is impaired, it does not receive enough oxygen and nutrients and can even die in severe cases.

Clinical manifestations, examination methods

The symptoms of alcoholic neuropathy are.

• Pains;
• hypoesthesia (decreased sensitivity of soft tissues);
• weakness in the legs;
• paralysis - inability to move;
• decreased volume in the lower extremities;
• decreased tone.

The patient constantly complains of a cold feeling in the legs.

Pain is one of the typical symptoms. Their characteristics are as follows:

• Localization – on the posterior surface of the tibia;
• In nature - painful, twisting;
• Severity – depending on the age and severity of the problem. The pain intensifies when the leg is squeezed on the posterior surface;
• Onset – episodic at first, then persistent, getting progressively worse over time.

Abnormalities are also detected during objective examination – using physical, instrumental and laboratory methods.

The physical exam consists of an examination and palpation.

During the investigation, among other things,

• swelling of the lower limbs;
• paleness or lability of the skin;
• Dark spots on the skin due to accumulation of melanin pigments.

• Increased sweating (usually on the feet) is noted;
• confirm the presence of edema;
• Sore muscles in the calf (at the back of the lower leg).

Impaired tendon reflexes are also detected on objective examination.

Instrumental methods are used to make a differential diagnosis with other diseases that have a clinical picture similar to the disease described. They are carried out:

Work in the USA and Mexico

Even as Kahlo gained recognition in Mexico, her health deteriorated rapidly, and an attempt to prop up her spine through surgery failed. Her paintings from this period include 'Broken Column' (1944), 'Without Hope' (1945), 'The Tree of Hope, Stand Firm' (1946) and 'Wounded Deer' (1946), which reflect her poor health. In her later years, Kahlo mostly lived in the Casa Azul. She mainly painted still lifes, depicting fruits and flowers with political symbols such as flags or doves. Concerned about portraying her political beliefs, she explained: 'I am very concerned about my paintings. Mainly because I want to make them useful for the revolutionary communist movement…. So far I've only managed to express myself honestly... I have to fight hard so that the small positive things that my health allows me to do also benefit the revolution, which is the only real reason to live'. Her style of painting also changed: her brushstrokes, previously delicate and careful, now became more hasty, her use of color bolder, and her overall style more intense and feverish.

In April and May of 1954, Kahlo was hospitalized again. In the spring of the same year she took up painting again after a year's break. Her last paintings are 'Political Marxism Will Give Health to the Sick' (c. 1954) and 'Frida and Stalin' (c. 1954) and the still life 'Viva La Vida' (1954).

Legs, what do I need you for when I have wings to fly?

In 1950, Kahlo spent nearly a year at the ABC Hospital in Mexico City, where she underwent surgery to transplant new bones to her spine. This led to a complicated infection and required several more surgeries. After her discharge from the hospital, she lived mostly in La Casa Azul, getting around in a wheelchair and on crutches. In the last years of her life, Kahlo devoted herself to political causes, as far as her health permitted. In 1948 she rejoined the Mexican Communist Party and campaigned for peace, including signing the Stockholm Appeal.

In August 1953, Kahlo had to have her right leg amputated to the knee due to gangrene.

She fell into severe depression and anxiety, and her addiction to painkillers increased. When Rivera had another affair, she attempted suicide by overdosing. In February 1954 she wrote in her diary: 'Six months ago my leg was amputated, I was tortured for centuries, at times I almost lost consciousness. I still feel like killing myself. Diego keeps me from it because I imagine that he will miss me…. But I've never suffered so much in my life. I'll wait a little...'

In her final days, Kahlo was mostly bedridden from bronchitis, although on July 2, 1954 she made public appearances and took part in a demonstration with Rivera against the CIA invasion of Guatemala. It seemed as if she had a premonition of her death, as she spoke to visitors about it and drew skeletons and angels in her journal. The last drawing represented a black angel, which biographer Hayden Herrera interprets as an angel of death. It was accompanied by her last words, which she wrote: 'I look forward to leaving - and hope never to return - Frida'.

The demonstration made her illness worse, and by the night of July 12, 1954, Kahlo had a high fever and was in severe pain. On July 13, 1954, around 6 a.m., a nurse found her dead in her bed. Kahlo was 47 years old. The official cause of death was pulmonary embolism, although no autopsy was performed. Herrera claimed that Kahlo actually committed suicide. The nurse, who counted Kahlo's painkillers to control her drug use, claimed that Kahlo overdosed on the night of her death. She was prescribed the maximum dose of seven pills, but took eleven. That night, she also gave Rivera a wedding anniversary gift, more than a month in advance.

What happened to the world while you slept?

▪️ Olympic figure skating champion Roman Kostomarow had to amputate both shins and one arm, reports MK. According to the newspaper, the athlete was reconnected to a ventilator. 'Kostomarov has come to his senses, his wife, figure skater Oksana Domnina, is by his side all the time. <. >He was taken off the ventilator just hours after it was realized he was able to breathe on his own. His body was very weak and he had lost more than 50 kg. His other arm has turned black and doctors are awaiting a decision on amputation'. – said the quoted source.

▪️ Alexander Bastrykin, head of the Russian Investigative Committee, has ordered an investigation into the arrest warrants issued by the International Criminal Court (ICC) in The Hague against President Vladimir Putin and Child Rights Commissioner Maria Lvovskaya-Belowa. This is reported by the 'Kommersant'. 'The chairman of the Russian Investigative Committee has instructed the agency's headquarters to organize a procedural review in connection with the illegal issuance of arrest warrants against Russian citizens by the International Criminal Court'. – said the press service of the investigative committee in a statement. Russia does not recognize the jurisdiction of the International Criminal Court.

▪️ A bill on citizenship of children born abroad has been tabled in the Duma, RIA Novosti reports. He would amend the citizenship law, according to which a child receives Russian citizenship if one parent has Russian citizenship at the time of birth. The birthplace of the child would not matter. It also proposes to abolish the need for written consent from the other foreign parent for a child to receive Russian citizenship.

▪️ American singer Billie Eilish made her acting debut in Donald Glover's miniseries 'Roy', reports Rolling Stone. In the series with thriller elements, the well-known actress plays the role of the mysterious Eve, who is said to have the ability to heal, in the fourth installment. The show itself is about a girl who becomes possessed by a pop star named Ni'Jah and destroys her life. So far, Billie Eilish has only appeared in documentaries and has also lent her voice to an episode of the Simpsons animated series How Billie Met Lisa.

What is in store for Voronezh residents today

At the moment it is 0° outside. During the day it will be +3°, cloudy with clear skies and without significant precipitation.

Käser Luthy experimented on a baby before his death.

A Voronezh man who disappeared after the March 8 celebrations was found dead.

A man was rescued in Voronezh after climbing the ledge of a skyscraper.

Sub-zero temperatures are expected in Voronezh this weekend.

Volunteers in Voronezh report the search for a missing 11-year-old boy.

The sixth grader stabbed his classmate in the chest during a 'slumber party'.

A 23-hectare cemetery will be created between the cities of the Voronezh region.

A mobilized man from Voronezh was killed in an SWO.

A minibus runs over children and adults on the sidewalk (video).

Two residents of the Voronezh region died at the SWO.

The authorities have announced when the heating in Voronezh will be switched off.

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Roman Kostomarov's future: will he be able to return to normal life?

Well-known Russian doctor and Ice Age activist Roman Kostomarov announced today that he will only be able to return to normal life once he has recovered.

The doctor emphasized that the recovery process of the Olympic champion will most likely take a very long time. Osipov added that the poor prognosis was due to the patient's damage to all major organs, reports Podmoskovje Segodnya.

Kostomarov is now in the hospital for the third month. According to the specialist, the speed of recovery usually depends on the patient's immune status.

At the moment, no one can guarantee when Roman will be able to return to his normal life, but it is absolutely certain that this is not to be expected even in the foreseeable future.

Considering that the Olympic athlete has been ill for three months and has injuries in all organs, his recovery will take a long time. Maybe even several years. The speed of recovery depends on his immunity', Osipenko concluded.

Roman Kostomarov is doomed: the sad prognosis of the doctors

Roman Kostomarov's blood poisoning is still unstoppable. The organism fights, but has hardly any strength left. Doctors say they will amputate the other arm, but right now the surgery could be deadly. But even if the operation is successful, it will not solve the athlete's problems.

As physician Theodore J. Kwame explains, the second hand will be amputated. Ivashina, the quality of life of people who have had septicemia is reduced. The fact is, there are problems with learning, memory, concentration, and decision-making.

But the most dangerous thing is that sepsis patients are weakened. According to the information, a third dies after a year, and a sixth has physical and mental impairments. Some can no longer breathe independently, others suffer from depression or post-traumatic stress disorder afterwards.

On the second day, Kommunarka's medics determined that Kostomarov was already showing symptoms of post-traumatic stress disorder. The recovered figure skater yelled at his wife and medical staff, sparking a scandal.

In addition, almost half of patients with the same diagnosis end up in the hospital again within three months. This can be a recurrence of infection, acute kidney failure or cardiovascular disease.

• The reamputation is.
• Indications for amputation.
• Life after a leg amputation.
• Metatarsal amputation.
• The toe formation.
• Plastic amputation of the tibia according to Pirogov.
• traumatic amputation.
• What to do with amputated limbs?.