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Biomedical subjects

P Holstein

Publications and source records attributed to P Holstein.

At least 19 recordsLinked to original sources
PubMed1996

Chronic critical leg ischaemia must include leg ulcers.

OBJECTIVES: In a previous series on conservative treatment in patients with leg ulcers and severe arterial occlusive disease (systolic digital blood pressure (SDBP) < 30 mmHg) a 70% risk of leg amputation and a negligeable potential for ulcerhealing was found. This series assess the efficacy of arterial reconstruction in such patients. DESIGN: Retrospective study of consecutive patients in a department of vascular surgery and of dermatology in cooperation with the wound healing center. MATERIAL AND METHODS: Thirty-nine patients with 42 ulcerated legs underwent arterial revascularisation. 88% of the procedures were distal to the inguinal ligament. MAIN RESULTS: One patient died postoperatively (3%). Seven (18%) had wound complications, but none had graft infections. After 1 year the cumulative secondary patency was 90%, ulcer healing 70% and the limb salvage 90%. Thus only four legs (10%) had been amputated. CONCLUSIONS: Arterial revascularisation for leg ulcers is indicated when conservative treatment fails. Legs with ulceration and SDBP < 30 mmHg should be included in the concept of chronic critical ischaemia.

Aged↗
PubMed1996

[Reduced frequency of amputation in diabetic patients].

The number of major amputations performed for vascular disease in Bispebjerbx Hospital, Copenhagen, has decreased from 122 to 29 per year during the period 1981 to 1994. In diabetic patients the frequency decreased from 25.5/100,000 to 5.5/100,000, i.e. a reduction of 78 percent, and in non diabetics it decreased from 42.2/100,000 to 14.6/100,000, i.e. a reduction of 65 percent. During the period vascular surgery has become a surgical specialty (1983), bypass to infra-popliteal arteries (from 1988) and graft surveillance by colour duplex scanning (from 1983) has become routine and in 1993 a diabetic foot center was established. Initial experience with a diabetic foot center in a vascular surgery unit is reported.

Adult↗
PubMed1995

Dietary effects on fat deposition and fatty acid profiles in muscle and fat depots of Friesian bull calves.

Dietary effects on fat deposition, cholesterol level, and fatty acid profiles of muscle and fat depots in Friesian bull calves were evaluated in two trials. In Trial 1 (eight pens of seven Friesian bull calves), three levels of ME (10.4, 10.9, 11.7 MJ/kg of DM; diets L, M and H, respectively) were offered to three groups of calves throughout the entire experimental period. Calves of the fourth group were fed diet M for the first 80 d and diet L thereafter (Treatment ML). Calves were 185 +/- 15 d of age and 215 +/- 18 kg BW at the start of the trial and were slaughtered when they reached a predetermined equal degree of fatness, in a BW range of 480 to 580 kg, and an age range of 417 to 548 d. In Trial 2, four groups of calves (eight pens of seven Friesian bull calves) had free access to diets of the same ME (11.7 MJ/kg of DM) but that differed in either CP content (11.3 vs 13.4%) or had poultry litter substituted for part of soybean meal at the equivalent CP. Calves were 18o +/- 13 d of age and 240 +/- 19 kg BW at the start of the trial and were slaughtered after 232 +/- 11 d, at 508 +/- 22 kg BW. In both trials, dressing percentages and carcass percentages of kidney, pelvic, and cod fat depots were recorded at slaughter, and samples of the 12th rib longissimus muscle with its subcutaneous fat were obtained for lipid analyses. Increasing the ME concentration shortened the growing period and tended to increase carcass depot fat percentage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1994

Halving the number of leg amputations: the influence of infrapopliteal bypass.

A retrospective review of amputations in patients with vascular disease during 10 years in Bispebjerg Hospital was undertaken. There were 1383 amputations leading to 1167 final level amputations. In previously independent patients there were 482 below knee amputations (BKA), 476 above knee amputations (AKA) and 43 had disarticulations in the ankle, knee or hip. During the period studied the number of final level amputations in independent patients were halved from 122 in 1981 to 58 in 1990. A similar reduction was also found in the total number of amputations: from 171 to 90, and in the number of reamputations: from 35 to 21. However, amputations in patients from long stay institutions remained at a constant level by on average 17 per year. The decrease in amputation rate took place synchronously with an increasing use of bypass to crural and pedal arteries as well as an overall increase in vascular reconstructions and angioplasties of more than 100%. However, the BKA/AKA ratio decreased from 1.12 to 0.67 (p < 0.005).

Adult↗
PubMed1992

Thromboembolectomy in geriatric patients from long-stay wards.

The results of arterial embolectomy with the Fogarty balloon catheter in patients over 70 years of age with acute ischaemia of the lower limbs were evaluated. Twenty-three geriatric patients from long-stay wards, median age 81 years, range 70-92, were compared with 45 independent patients, median age 81 years, range 70-91, living in their own homes. The period of ischaemic symptoms before admission was on average shorter for patients coming from long-stay wards, but the outcome was less successful. Recurrent occlusion during the first postoperative month took place in 12 patients (52%) from long-stay wards as compared to eight (18%) among independent patients (p < 0.01). The mortality was 35% and 18% respectively (p > 0.2). After six months, only 35% of patients from geriatric institutions were alive with a functional extremity as compared to 62% in the independent group (p > 0.01).

Aged↗
PubMed1992

Percutaneous transluminal angioplasty in 226 iliac artery stenoses: role of the superficial femoral artery for clinical success.

We reviewed the results of 174 consecutive percutaneous transluminal angioplasties (PTA) for 226 iliac artery stenoses (mean length 1.6 cm, range 0.2-9.6 cm) in 150 patients with lower limb ischaemia. Vascular intervention was indicated by intermittent claudication in 123 and critical ischaemia in 51 (29%) limbs. There were 12 (7%) failed guide-wire recanalizations. Four (2%) serious complications from puncture site haemorrhages or peripheral embolizations were handed surgically and caused one major amputation. Five-year patency in 162 successful dilatations was 68% primarily and 81% secondary to vascular surgical reconstructions during an average 28 (range 1-60) months of observation. One hundred and thirteen (70%) limbs improved clinically. In 95 limbs treated exclusively by iliac PTA, clinical improvement was achieved in 38/47 (81%) limbs with patency and 24/48 (50%) limbs with occlusion of the superficial femoral artery (SFA) (p < 0.003), whereas vascular patency of iliac PTA was unaffected by status of the SFA. Five-year limb salvage rate was 50% in limbs with critical ischaemia. We conclude that PTA for iliac artery stenoses is a low-risk procedure offering acceptable clinical results provided the SFA is patent. As an adjunct to distal bypass surgery, iliac PTA improves inflow without the requirement for major aorto-iliac surgery and may extend indications for vascular intervention in patients with lower limb ischaemia.

Adult↗
PubMed1991

Femoro-popliteal artery occlusions treated by percutaneous transluminal angioplasty and enclosed thrombolysis: results in 55 patients.

Removal of fibrin from the site of a newly dilated femoro-popliteal occlusion may be an attractive way of preventing rethrombosis. A double balloon catheter with a dilating tip balloon and an occlusive balloon 10, 15 or 20 cm approximately were introduced percutaneously. Following successful dilatation of femoro-popliteal occlusions, the balloons were inflated on both sides of the lesion. The dilated segment was then isolated from the circulation. Through a sideport between the balloons 5 mg of tissue type plasminogen activator and 1000 IU of heparin were installed within the segment for 30 min. The authors report the results of 53 technically successful dilatations of femoro-popliteal occlusions followed by enclosed thrombolysis. A 100% patency at 3 months was noted in 33 patients having one to three run-off arteries, and the one year patency was 90%. In 20 patients, with no infrapopliteal run-off artery, four rethrombosis occurred within 24 h, and the one year patency was 62%. This difference is significant. (Log rank test, Chi-square = 4.73, p less than 0.05). We conclude that enclosed thrombolysis prevents early reocclusion following PTA of femoro-popliteal occlusions provided that at least one infra-popliteal artery is patent.

Aged↗
PubMed1991

The results of completion angiography after acute lower limb thromboembolectomy.

The results of completion angiography after acute thromboembolectomy with a Fogarty balloon catheter were evaluated. There were 62 patients (median age 72 years, range 44-92 years) and completion angiograms were made in 44 of them (71%). Incomplete runoff was demonstrated in 26 patients (59%) and rethromboembolectomy or vascular reconstruction was made in 18 cases (41%) under the same anaesthesia, while additional vascular surgery was technically impossible in 8 patients (18%). Supplementary surgery resulted in radiological improvement in 56% of operated cases. Reocclusion rate after 6 months was 50% in patients without patent tibials compared to 15% in patients with two or three patent tibial arteries (P less than 0.05). Eighteen patients had no completion angiograms after thromboembolectomy and 5 (28%) required early reoperation due to ischaemia. Completion angiograms are advocated in all cases of acute thromboembolectomy before the patient leaves the operating table.

Acute Disease↗
PubMed1990

Early rethrombosis in femoropopliteal occlusions treated with percutaneous transluminal angioplasty.

One hundred and thirty-seven consecutive percutaneous transluminal angioplasties (PTA) were performed for femoropopliteal vascular disease including 58 stenoses and 79 total occlusions. Nine occlusions could not be crossed with the guidewire, but in the remaining 128 the haemodynamic and clinical success as well as vascular patency were evaluated. The results were grouped into the following subsets: the indication for PTA, the severity of the vascular lesion, the crural run-off and the length of lesion. The results were in every respect poor with total occlusions when compared with stenoses. This was explained by a high incidence (41%) of rethrombosis within hours of dilatation. Early rethrombosis was seen with all lengths of occlusion (1-27 cm) with no statistically significant difference from other subsets. This study concludes that conventional PTA in femoropopliteal occlusions should be reserved for cases of limb salvage, preferably in patients who are technically inoperable. We suggest a new technique of segmentally enclosed thrombolysis to prevent early rethrombosis after PTA in femoropopliteal occlusions.

Aged↗
PubMed1990

Outcome in 282 lower extremity amputations. Knee salvage and survival.

Lower-extremity amputation for arterial insufficiency was performed in 282 cases ineligible for vascular surgery. In 203 cases (Group I), amputation was elective without previous vascular surgery. In 14 cases (Group II), amputation followed recent vascular reconstruction, and in 12 cases (Group III) amputation was performed after failed thromboembolectomy. In 53 cases (Group IV), amputation was done acutely, i.e., as a life-saving procedure because of septicemia. The results as regards both knee salvage and survival were much better in Groups I and II than in Groups III and IV. We conclude that knee salvage is poor and mortality high after acute amputations and after failed thrombembolectomy. These factors should be taken into account when comparing series from different centers.

Adult↗
PubMed1990

Prognostic significance of digital blood pressure in leg ulcer patients.

In a consecutive series of patients with ulceration of the lower leg referred to the dermatological in-patient department during a 9-month period, a systolic digital blood pressure level (SDBP) below 60 mmHg was used to identify patients with complicating arterial occlusive disease (AOD) of the legs. AOD was diagnosed in 25 patients and stasis ulcers from venous disease (SDBP greater than or equal to 60 mmHg) in 38 patients of the same ages. Patients with ulceration from other causes were excluded. After 1 year, 48% of the patients with AOD and 5% of those with stasis ulcers had died. In the AOD group, 11 legs were amputated. Our figures show that the SDBP is valuable in identifying high-risk patients.

Adult↗
PubMed1990

Aorto-femoral digital subtraction angiography in old patients with symptoms of peripheral arterial disease. Findings, efficacy, and consequences.

Seventy-four patients between the ages of 75 and 88, with disabling intermittent claudication or critically ischaemic legs underwent an aorto-femoral digital subtraction angiography (DSA). Thirty-six procedures were intraarterial and 38 were intravenous. There were no major complications. The degree and localisation of the arterial lesions did not differ from earlier reports based on conventional arteriography. In 67 patients, on the basis of the DSA examination, a decision could be made as to whether vascular surgery was feasible. In 28 of 57 non-diabetic patients (49%), invasive treatment was carried out in the form of vascular reconstruction, thromboembolectomy, or percutaneous transluminal angioplasty. None of the 17 diabetic patients could be treated invasively.

Aged↗
PubMed1989

Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator.

To establish whether re-occlusion of the femoral artery could be prevented, in 6 consecutive patients undergoing percutaneous transluminal angioplasty (PTA) for superficial femoral artery occlusion the recanalised segment was isolated, with a 7-French double-balloon catheter. 5 mg recombined human tissue-type plasminogen activator (rt-PA) and 1000 IU heparin were then infused into the enclosed space for 30 minutes, followed by intravenous heparin for 24 hours. At 10 and 30 days all 6 patients had evidence of recanalisation and remission of symptoms. Mean ankle-arm pressure index improved by 72% at 24 hours, by 118% at 10 days, and by 103% at 30 days after the procedure. No patients had major complications. Treatment of superficial femoral artery occlusions by PTA with rt-PA and intravenous heparin seems to prevent rethrombosis.

Aged↗
PubMed1989

The ischaemic leg: a long-term follow-up with special reference to the predictive value of the systolic digital blood pressure. Part I: No arterial reconstruction.

The course of 53 patients presenting with 76 legs with ischaemia, defined by blood pressure on the big toe below 30 mmHg, were investigated. The series consists of those patients who after an angiography were considered non-candidates for arterial reconstructive surgery. There were 38 limbs with low pressure and severe ischaemic symptoms, i.e. rest pain and/or gangrene and 38 limbs with low pressures and only intermittent claudication or no leg symptoms at all. There were statistically significant differences in the fate of the limbs in the two groups, the first group suffering a 68 per cent risk of amputations compared to only 16 per cent in the second group. The corresponding risk of death was approximately 60 per cent and 10 per cent. The social fate was poor in the group with rest pain and/or gangrene due to the high number of amputations.

Adult↗
PubMed1989

The ischaemic leg: a long-term follow-up with special reference to the predictive value of the systolic digital blood pressure. Part II: After arterial reconstruction.

Ninety-five patients with 122 legs with a systolic blood pressure on the big toe below 30 mmHg were the subject of arterial reconstructive surgery. Investigating the limb survival rate we found the systolic blood pressure on the big toe to be the most important predictor, whereas there was found no predictive value of the ankle pressure/index. Preoperative clinical symptoms, which are closely related to the digital blood pressure, were significant predictors of the limb survival rate: the low-pressure limb with no symptoms or intermittent claudication had a significantly higher survival rate than the limb with rest pain and/or gangrene. Following arterial reconstructive surgery the social fate of patients with threatened legs was fairly good as 83% became fully independent.

Adult↗
PubMed1989

Limb salvage in diabetics with foot ulcers.

The healing results in 491 ulcers in 272 diabetic patients are reported. Soft moulded insoles and shoe corrections were the main part of the therapy. There were 329 (67%) neuropathic, 87 (17%) traumatic, 44 (9%) ischaemic and 31 (6%) ulcers of other various pathogenesis. Thirty seven per cent of the ulcers were complicated with invasive infection. Within the period of observation of 18 months (3-39 months) healing was obtained in 79% of the patients (88% of the ulcers) and major amputation was carried out in 8% (4% of the ulcers). There were 21 major amputations, which in 18 cases was due to ischaemia. Thus in only 3 cases (1% of the patients) neuropathy as complicated by invasive infection caused major amputation. Fifty nine ulcers (12%) were classified as relapsing ulcers or ulcers with new localizations and were caused by severe deformity of the foot (58 cases) often in combination with neglect of prophylaxis (7 cases). Only one recurrent ulcer was caused by ischaemia. The series shows that shoe corrections and insoles are effective in treating diabetic neuropathic ulcers. Recurrent ulcerations are caused by severe foot deformity and neglect of therapy. Loss of limbs is caused by ischaemia and invasive infection.

Adult↗