Biomedical subjects
D L Steed
Publications and source records attributed to D L Steed.
Internal jugular vein reconstruction in bilateral radical neck dissection.
Explore the source record for details and available documents.
Endovascular stent-graft repair of common iliac artery-to-inferior vena cava fistula.
Explore the source record for details and available documents.
Recurrence rate of diabetic neurotrophic foot ulcers healed using topical application of growth factors released from platelets.
The purpose of this study was to determine the recurrence rate of diabetic neurotrophic foot ulcers that had healed in a treatment protocol using topically applied growth factors released from platelets. Thirty-six patients with diabetic neurotrophic foot ulcers were entered into a randomized prospective double-blind 20-week trial of topically applied platelet growth factors or buffered saline dressings. Ulcers had been present for 15.5 months (mean, range 2 to 60 months). Sixteen patients (44%) healed and were followed up for as many as 30 months to determine the rate of ulcer recurrence. Eleven patients (68.8%) had ulcers that recurred, including 10 treated with platelet growth factors and one treated with buffered saline solution. These ulcers had been present for 20 months (range 5 to 60 months) before healing. Average time to ulcer recurrence was 2.2 months (range 0.25 to 7 months). Five ulcers (31.2%) remained healed, including four treated with platelet growth factors and one treated with buffered saline solution. These healed, nonrecurring ulcers had been present for 5 months (range 2 to 6 months) before healing. Average follow up was 25 months (range 24 to 30 months). Ulcers were more likely to recur if they had been present longer before healing. If patients were not compliant in wearing footwear to protect the healed ulcer, the ulcers were prone to early recurrence. These data indicate that ulcers healed by using growth factors in the form of a platelet growth factors did not have more durable skin over the ulcer and were prone to early ulcer recurrence.
Efficacy and safety of becaplermin (recombinant human platelet-derived growth factor-BB) in patients with nonhealing, lower extremity diabetic ulcers: a combined analysis of four randomized studies.
The results of a combined analysis and separate analyses of four multicenter, randomized, parallel group studies that evaluated the effects of once-daily topical administration of becaplermin gel for the treatment of chronic, full thickness, lower extremity diabetic ulcers are presented. The four studies included a total of 922 patients with nonhealing lower extremity diabetic ulcers of at least 8 weeks' duration. Following initial complete sharp debridement of the ulcer, patients were randomized to receive a standardized regimen of good ulcer care alone, good ulcer care plus placebo gel, or good ulcer care plus becaplermin gel-30 microg/g, or good ulcer care plus becaplermin gel-100 microg/g, with various combinations of regimens used in the four studies. Safety was assessed by monitoring adverse events and by clinical laboratory evaluations. Meta-analytic statistical techniques were used in the combined analysis to establish homogeneity of treatment comparisons across studies. Based on an analysis of patients with baseline ulcer area common to all trials (</= 10 cm2), representing 95% of all patients, becaplermin gel-100 microg/g significantly increased (p = 0.007) the probability of complete healing compared with placebo gel. It was determined that for the median ulcer area of these patients, which was 1.5 cm2, the becaplermin gel-100 microg/g treatment group showed a 39% increase in complete healing compared with that of the placebo gel treatment group (50% vs. 36%, respectively, p = 0.007). Becaplermin gel-100 microg/g significantly decreased (p = 0.01) the time to complete healing compared with placebo gel, with the 35th percentile of time to complete healing being reduced by 30% (14.1 weeks vs. 20. 1 weeks, respectively). In patients with ulcers </= 5 cm2 at baseline (a more homogeneous group), becaplermin gel-100 microg/g also significantly increased the incidence of complete healing with a similar decrease in the time to healing. Adverse events reported during treatment or during a 3-month follow-up period were not unexpected for this patient population and were similar in nature and incidence across all treatment groups. We therefore conclude that treatment with becaplermin gel at a dose of 100 microg/g once daily, in conjunction with good ulcer care, is effective and well tolerated in patients with full thickness lower extremity diabetic ulcers.
Venous Leg Ulcers: a guide for patients and care givers.
Explore the source record for details and available documents.
Randomized trial of topically applied repifermin (recombinant human keratinocyte growth factor-2) to accelerate wound healing in venous ulcers.
About 600,000 people in the United States are estimated to be affected by venous ulcers. The cornerstone of care of chronic venous ulcers involves the application of compression bandages. Other therapies include treatment of associated infection, treatment for edema and inflammation, and debridement when necessary. Repifermin, a recombinant human KGF-2 (fibroblast growth factor-10), exerts a proliferative effect on epithelial cells, in vitro and in vivo, and has been shown to accelerate wound healing in several experimental animal models. A randomized, double-blind, parallel-group, placebo-controlled, multicenter study was conducted to evaluate the safety and efficacy of topical repifermin treatment, for 12 weeks, in the healing of chronic venous ulcers in 94 patients. Repifermin was shown to accelerate wound healing, with significantly more patients achieving 75% wound closure with repifermin than with placebo. The treatment effect appeared more marked for a subgroup of patients with initial wound areas < or = 15 cm2 and wound ages of < or = 18 months. A longer duration of treatment (e.g., 26 weeks) may allow better differentiation of the benefit of repifermin compared with placebo, particularly with respect to complete wound closure. The safety assessment showed that repifermin was well tolerated.
The management of aortoenteric and paraprosthetic fistulae.
Aortoenteric and aortic paraprosthetic fistulae are devastating complications. Most authors recommend total excision of the graft and revascularization of the lower extremities by extra-anatomic bypass. We reviewed the University of Pittsburgh experience with these fistulae in 15 patients between 1977 and 1987. There were 9 aortoenteric fistulae (AEF) and 6 paraprosthetic fistulae (PPF). Seven of the 9 AEF had no abscess surrounding the graft, but communication of the intestine with the aortic anastomosis. One patient died during operation. Six patients underwent a local repair or in situ replacement of the graft. All 6 of those patients survived operation without limb loss. Two of the 9 patients with AEF had evidence of graft infection and underwent total excision of the graft and extra-anatomic reconstruction. Both patients died, one of sepsis and one of aortic stump rupture. All 6 patients with PPF had clinical and operative evidence of overt graft infection and underwent total graft excision and extra-anatomic bypass. Two of these patients died secondary to sepsis. We conclude that AEF, without evidence of graft infection, were safely treated by local repair. Patients with PPF had infected grafts requiring graft removal with significant morbidity and mortality.
Pulmonary function after hemorrhagic shock in pigs.
Explore the source record for details and available documents.
Oxygen diffusion in chronic venous ulceration.
A diffusion barrier to oxygen caused by fibrin deposition around dilated, proliferating capillaries in patients with venous hypertension may contribute to the development of venous ulceration. This diffusion barrier was studied in 18 patients with venous ulcers using the transcutaneous oxygen (TcPO2) monitor (TCM204 Radiometer, America). TcPO2 sensors were placed adjacent to venous ulcers on lower limbs and on the chest and foot of each patient. Readings were taken after a sensor temperature of 44 degrees C was reached (10-15 minutes). TcPO2 values were markedly decreased in skin adjacent to the ulcers (10 +/- 2 mmHg) compared with those of the chest (64 +/- 2 mmHg) and foot (43 +/- 2 mmHg). Inhalation of 100% oxygen for 10 minutes increased chest TcPO2 in all patients (145 +/- 8 mmHg) and increased TcPO2 in skin around the ulcers in 17 of 18 patients (61 +/- 13 mmHg). This study supports the existence of a local pathologic barrier to oxygen diffusion in patients with venous ulcers.
Effect of compliance and diameter on stress at arterial anastomoses.
Explore the source record for details and available documents.