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J Vaucher

Publications and source records attributed to J Vaucher.

18 recordsLinked to original sources
PubMed2005

Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease.

BACKGROUND: Major amputation is a dreaded event with high mortality and morbidity. However, few studies have investigated the epidemiology of amputation in the elderly over time, in the face of evolving management and prevention efforts. METHODS: We undertook a retrospective study to determine the incidence rate, etiology and prognosis of major lower limb amputations (transtibial or higher) in elderly patients (> 65 years). Cases were identified over a 10-year period in the Geneva (Switzerland) area, where all amputations are performed in a single center and reliable demographic data are available. RESULTS: The rate of amputation varied from 1.8 to 11.4/10000 patients/year, increasing with age and male gender. Diabetes was present in 48% patients, and conferred a 10 times higher risk of amputation. Severe peripheral arterial disease (PAD) was present in > 94% patients. The prognosis remains poor, 47% patients had died after two years and only 53% patients could be equipped with a prosthetic limb. Over 10 years we found a progressive increase in age at amputation; this encouraging increase was mostly accounted for by diabetic patients (> 6 months per year). CONCLUSIONS: The rate of amputation observed among elderly patients was low. Neither the rate nor the prognosis improved over the decade studied. However, the age at amputation increased by > 6 months/year, particularly in diabetic amputees, suggesting that current management successfully delays amputation. Amputations were almost exclusively performed for severe PAD. Further reduction in the rate of amputation will require progress in the prevention and management of PAD.

Aged↗
PubMed1999

Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up.

BACKGROUND: Diabetic foot lesion is associated with increased morbidity and high resource use. Although early amputation has been advocated in case of osteomyelitis, conservative treatment is a more attractive alternative. OBJECTIVE: To identify criteria predictive of failure of conservative treatment of diabetic foot ulcer at time of admission to the hospital. METHODS: We conducted a 5-year retrospective cohort study with prospective long-term follow-up of all diabetic patients admitted for a foot lesion at a large (1600-bed) teaching institution. Predetermined criteria were used for the diagnosis and classification of diabetic foot lesions (Wagner classification). Study variables included patient demographics and clinical parameters related to infection and diabetes. The average follow-up after hospital discharge was 2 years. Failure of conservative treatment was the main outcome measure. Independent predictor variables were selected by logistic regression analysis. RESULTS: A total of 120 diabetic patients were admitted for foot lesions; complications of contiguous osteomyelitis, deep tissue involvement, and/or gangrenous lesions occurred in 78 (74%) of the 105 patients for whom charts were available. Fourteen patients (13%) underwent immediate amputation. Conservative treatment was successful for 57 (63%) of the 91 remaining patients. Success was achieved in 21 (81%) of 26 patients presenting with skin ulcer, 35 (70%) of 50 patients with deep tissue infection or suspected osteomyelitis, and 1 (7%) of 15 patients with gangrene (P<.001, chi2 for trend). Independent factors predictive of failure were the presence of fever (odds ratio [OR]=1.1 per degrees Celcius; 95% confidence interval [CI], 1.0-1.2) and increased serum creatinine level (OR=1.002 per micromoles per liter; 95% CI, 1.0020-1.0021) on admission, prior hospitalization for diabetic foot lesion (OR=1.4; 95% CI, 1.2-1.6), and gangrenous lesion (OR=1.8; 95% CI, 1.5-2.2). Other patient characteristics, demographics, duration of diabetes mellitus, neutrophil count, or the anatomical site of the lesion failed to predict outcome. CONCLUSIONS: Conservative treatment, including prolonged, culture-guided parenteral and oral antibiotics, is successful without amputation in a large proportion of diabetic patients admitted for a foot skin ulcer or suspected osteomyelitis. Future studies comparing early amputation with novel therapeutic strategies for severe diabetic foot infection should take into account currently identified factors that predicted failure of conservative treatment on admission to the hospital.

Adult↗
PubMed1993

[Cost of training a diabetes mellitus patient. Effects on the prevention of amputation].

Cost of disease is a complex notion: financial cost, psychological cost for those who have cope with a chronic disease. But there is also another cost which has not yet sufficiently been taken into account: the cost of resistance to change. It has largely been shown that patient education could result in major cost-saving as well as improvement of quality of life. Why is there such a resistance from health care providers, health policy planners for implementation of patients education programs? These resistances may well be part of the real cost of efficient control of a disease and like in the case of diabetes, prevention of acute and chronic complications. Education and training of patients has enabled us to decrease markedly lower extremities amputations: 12 times less above knee amputations, reduction by half of below knee amputations and a four fold decrease of toe amputations at the University Hospital of Geneva, Switzerland.

Age Factors↗
PubMed1989

Metabolic and clinical consequences of changing from high-glucose to high-fat regimens in parenterally fed newborn infants.

To evaluate the metabolic and clinical consequences of changing from high-glucose to high-fat regimens during initiation of parenteral nutrition, we performed 22 studies in 11 newborn infants (birth weight (mean +/- SD) 2.54 +/- 0.54 kg, gestational age 37 +/- 3 weeks, postnatal age 8 +/- 3 days) maintained in a constant thermal environment. In a paired design, two isoproteinic (2.4 +/- 0.2 gm/kg/day) and isocaloric (64 +/- 6 kcal/kg/day) regimens differing by source of energy (high glucose vs high lipid) were infused on consecutive days. Environmental and body temperatures were recorded during a 4-hour period, and 24-hour urinary excretions of catecholamines, nitrogen, and C peptide were measured. Despite constant incubator and average skin temperatures, the rectal and interscapular temperatures rose significantly when the high-glucose regimen was changed to a high-lipid regimen. The specific locations of these changes in body temperature suggested brown fat activation. A significant drop in nitrogen retention (63 +/- 9% vs 56 +/- 10%) during the lipid infusion could be further evidence of a metabolic adaptation to the rapid change in energy substrates.

C-Peptide↗
PubMed1988

Environmental temperature control in very low birth weight infants (less than 1000 grams) cared for in double-walled incubators.

To evaluate the effect of fluctuations in environment and body temperatures on preterm infants, we recorded these variables in very immature newborn infants (birth weight less than 1000 gm) cared for in double-walled incubators (Air-Shields model C-100 and Ohio model IC). Both incubators maintained environmental temperatures corresponding overall to the set point, despite incubator openings. Under skin temperature servocontrol, however, environmental temperature fluctuations were greater than 2 degrees C even in strictly controlled conditions. The pattern of incubator temperature fluctuations depended on the set point rather than on the type of incubator (conventionally heated or heated by warm air blown between the double walls). The long-term clinical significance of the incubator temperature variability remains to be determined; the choice between air and skin servocontrolling should depend in part on the need for environmental stability.

Body Temperature↗
PubMed1986

[Determination of the amputation level by transcutaneous PO2 measurement and distal arterial systolic pressure].

Transcutaneous oxygen partial pressure measurement (TcPO2) using a polarographic probe heating the skin at 44 degrees C provides informations about the capacity of blood to supply skin with oxygen. As oxygen is necessary for tissue survival, TcPO2 could constitute an adequate parameter for the determination of an amputation level. Among 67 amputations performed between 1983 and, 1984, we included in this study 34 patients (35 amputations), in whom TcPO2 was preoperatively measured (24 males, 10 females, mean age 67 years, range 19-86 years). Twenty two were diabetics. Twenty patients suffered from severe ischemia (stage Fontaine 4); 13 patients suffered from chronic diabetic lesions or/and osteomyelitis and two patients suffered from frostbite. The follow-up period lasted until operative wound was healed or a more proximal amputation was undertaken (mean 2.5 months, range 15 days to 10 months). Five operative wounds did not heal, so that a more proximal amputation was undertaken. TcPO2 was below 20 mm Hg in 3 of these 5 patients. TcPO2 was above 20 mm Hg in 24 among 30 patients in whom operative wound healed. When TcPO2 is above 20 mm Hg, the probability of operative wound healing is 92%. When TcPO2 is below 20 mm Hg, the risk of a more proximal amputation is 33%. Distal systolic blood pressure has no predictive value. It is concluded than when TcPO2 is above 20 mm Hg, the probability of healing of operative wound is clinically acceptable. When TcPO2 is below 20 mm Hg, 1 of 3 patients will be reamputated at a more proximal level, but healing does occur in 66% of patients.

Adult↗
PubMed1982

[Disarticulation of the knee. Surgical technic--prosthesis fitting].

The authors describe a modified technique for knee joint disarticulation surgery. Their approach provides two flaps, one medial and one lateral, which result in a posterior, longitudinal scar that remains outside the contact areas of the prosthesis. They abrade the lateral and posterior aspect of each condyle, peeling out the articular cartilage and re-covering the condyles with the joint capsule. This technique allows a satisfactory stability in prosthetic rotation, and improves the appearance of the artificial limb. For post-operative rehabilitation the authors use a tridimensional alignment jig and a prosthetic ankle with three degrees of freedom: flexion-extension, lateral-medial motion and rotation, making easier the swing phase while maintaining the obvious advantages of a pilon-type prosthesis.

Amputation, Surgical↗