Abstract：
:Deciding for an amputation in case of complex regional pain syndrome type I (CRPS-I) is controversial. Evidence for favorable or adverse effects of an amputation is weak. We therefore follow a careful and well-structured decision making process. After referral of the patient with the request to amputate the affected limb, it is checked if the diagnosis CRPS-I is correct, duration of complaints is more than 1 year, all treatments described in the Dutch guidelines have been tried and if consequences of an amputation have been well considered by the patient. Thereafter the patient is assessed by a multidisciplinary team (psychologist, physical therapist, anesthesiologist-pain specialist, physiatrist and vascular surgeon). During a multidisciplinary meeting professionals summarize their assessment. Pros and cons of an amputation are discussed, taking into account level of amputation and expectations about post amputation functioning of patient and team. Based on assessments and discussion a consensus based decision is formulated and the patient is informed. If it is decided that an amputation is to be performed, the amputation will follow shortly. If it is decided not to amputate, the decision is extensively explained to the patient. Incidence of patients suffering from therapy resistant CRPS-I referred for amputation is low and because referred patients are strongly in favor of an amputation, a randomized controlled trial will be difficult to perform. Hence level of evidence in favor or against an amputation will remain low. We therefore report our decision making process to facilitate discussion about this difficult and delicate matter.
journal_name
Med Hypothesesjournal_title
Medical hypothesesauthors
Schrier E,Dijkstra PU,Zeebregts CJ,Wolff AP,Geertzen JHBdoi
10.1016/j.mehy.2018.08.026subject
Has Abstractpub_date
2018-12-01 00:00:00pages
15-20eissn
0306-9877issn
1532-2777pii
S0306-9877(18)30608-Xjournal_volume
121pub_type
杂志文章abstract：:The reluctance of physicians to get involved with child abuse can be attributed to the problem of role conflict. Physicians derive their social authority from the Aesculapian tradition. This form of social authority is fragile and easily subverted, yet of utmost importance if physicians are to retain their effectivene...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(82)90028-7
更新日期：1982-04-01 00:00:00
abstract：:Postoperative cognitive dysfunction (POCD) is reported to occur frequently after all types especially cardiac surgery in elderly patients. It can be short-term or long-term and some cases even develop into Alzheimer's disease (AD). Although multi-risk factors associated with POCD have been identified, the etiology and...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2011.02.010
更新日期：2011-05-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2013.07.001
更新日期：2013-10-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2015.10.014
更新日期：2015-12-01 00:00:00
abstract：:Cancer cells proliferate and metastasize against the body's defense mechanisms due to their ability to change in response to challenges, both from the body's internal defenses as well as those from external sources, such as radiation and chemotherapy. This ability of tumor cell populations to change and grow in respon...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(94)90035-3
更新日期：1994-01-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/s0306-9877(03)00205-6
更新日期：2003-10-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(92)90007-y
更新日期：1992-01-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2020.109698
更新日期：2020-06-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2006.02.032
更新日期：2006-01-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(92)90123-t
更新日期：1992-11-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/s0306-9877(97)90305-4
更新日期：1997-03-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(91)90286-8
更新日期：1991-08-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2007.01.091
更新日期：2007-01-01 00:00:00
abstract：:Metastases from unknown primary tumours (MUP) are not an uncommon clinical problem. A hypothesis that discusses the plausible role of neoangiogenesis, as a central theme in the development of MUPs, is presented. Invasive cancers, which cannot or do not switch to the angiogenic phenotype, remain subclinical. In situati...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/s0306-9877(02)00221-9
更新日期：2002-09-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章,meta分析
doi：10.1016/j.mehy.2013.04.038
更新日期：2013-08-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2020.110007
更新日期：2020-11-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(79)90074-4
更新日期：1979-08-01 00:00:00
abstract：:This hypothesis named Salerian Addictive Potential (SAP) suggests that the addictive potency of any substance may be calculated with an algebraic equation of A=E/T(max)xt(1/2), where A is the addictive potency, E represents the euphoric potency, T(max) is the time to reach peak plasma concentration, and t(1/2) is the ...
journal_title：Medical hypotheses
pub_type： 杂志文章,评审
doi：10.1016/j.mehy.2010.01.008
更新日期：2010-06-01 00:00:00
abstract：:Reconciling the early promising results of radiation therapy in the treatment of epilepsy with the recent theory concerning the role of nonsynaptic mechanisms in focal epileptogenesis, it is suggested that the potential of irradiation as an alternative to temporal lobe resection in intractable epilepsy should be re-ev...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(80)90102-4
更新日期：1980-05-01 00:00:00
abstract：:"Consciousness" "mood," "identity" and "personality" are all emergent properties from whole-brain organizations; these are typically disturbed in psychiatric disorders. This work proposes that the underlying etiopathology of mental disorders originates from disturbances to global brain dynamics, or "Globalopathies" th...
journal_title：Medical hypotheses
pub_type： 杂志文章,评审
doi：10.1016/j.mehy.2013.09.032
更新日期：2013-12-01 00:00:00
abstract：:Sudden infant death syndrome (SIDS) is frequently associated with a mild infection, the incidence peaking during the third month of life. We hypothesize that the neonatal immaturity of both the acute febrile response and hypothalamus promote neonatal protection from SIDS. Vagal afferents modify the febrile response. V...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1054/mehy.1997.0695
更新日期：1999-06-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(93)90011-e
更新日期：1993-05-01 00:00:00
abstract：:The limb remote ischaemia postconditioning (RIPOC), a newly conceived idea of applying brief limb ischaemic stimulus after onset of the myocardial ischaemia but prior to the reperfusion, can offer the possibility of applying this cardioprotective strategy to the patients with acute myocardial infraction. Although incr...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2009.04.004
更新日期：2009-09-01 00:00:00
abstract：:Over a decade ago, I formulated the hypothesis that cumulative effects of exposure to high intracranial pressure (ICP) may contribute to the development of Alzheimer's disease (AD), though not necessarily in an exclusive way. In addition to individual ICP characteristics (high 'physiological' ICP) and diseases causing...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2004.01.013
更新日期：2004-01-01 00:00:00
abstract：:Since forced unilateral nostril breathing activates the contralateral brain hemisphere, an animal analogue of this technique could be provided by methylmethacrylate gluing large plastic pellets in either the right or left nostrils in a group of rats. A large number of physiological, pharmacological, and immunological ...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(89)90047-9
更新日期：1989-03-01 00:00:00
abstract：:Alzheimer's disease (AD) is the most frequent cause of dementia. Besides cognitive deterioration, patients with AD are prone to seizures - more than 20% of patients diagnosed with AD experience at least one unprovoked seizure and up to 7% have recurrent seizures. Although available antiepileptic drugs (AEDs) may suppr...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2016.12.006
更新日期：2017-02-01 00:00:00
abstract：:The data of literature are discordant about the role of mast cells in different types of neoplasms. In this paper the authors propose the hypothesis that tumor-associated mast cells may switch to different polarization states, conditioning the immunogenic capacities of the different neoplasms. Anti-inflammatory polari...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2019.109281
更新日期：2019-10-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2004.07.027
更新日期：2004-01-01 00:00:00
abstract：:Although once considered by biologists almost exclusively for their toxicity, reactive oxygen (ROS) and nitrogen (RNS) species produced within normal cells under baseline physiological conditions are now appreciated as redox regulators of a wide range of protein functions. Two families of enzymes, the NADPH oxidases (...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2019.109249
更新日期：2019-08-01 00:00:00
abstract：:We describe here a new technique for analyzing human growth curves using a first order kinetic representation. Plotting in ([h infinity-ht)/h infinity] vs time (where h infinity and ht represent the final and instantaneous heights) transforms growth curves into 3 linear phases and 2 interphases. These growth parameter...
journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/0306-9877(85)90073-8
更新日期：1985-02-01 00:00:00
