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Biomedical subjects

P Holstein

Publications and source records attributed to P Holstein.

At least 55 records · Page 3Linked to original sources
PubMed1985

Arterial embolism of the legs. A follow-up study of 252 patients.

This retrospective study of 279 embolectomies in 252 patients shows a mortality of 27%, and an amputation rate of 15% within the first month after the embolectomy. The mortality as well as the rate of amputations decreased through the first year. After this period the mortality was comparable to that of a normal population and the rate of amputation was negligible. The mortality rate as well as the number of amputations increased with increasing time-lag of the embolectomy. In addition, the rate of amputation increased with preexisting intermittent claudication. There was no significant difference in amputation rate between limbs with and without palpable pulsations in the groin on admission, but 8 out of 103 limbs without groin pulsations had successful major vascular reconstruction performed after failing embolectomy in contrast to none in the group where pulsations were present. In 28 patients the embolectomy was followed by impairment of renal function and 14 of these died. It is concluded that embolectomy must be performed as early as possible, vascular reconstruction must be considered if the embolectomy fails to revascularize the limb, preventive measures should be taken against renal failure, i.e. the myonephropathic-metabolic syndrome.

Acute Kidney Injury↗
PubMed1984

The distal blood pressure predicts healing of amputations on the feet.

The healing of digital and transmetatarsal forefoot amputations was compared with the systolic digital and ankle blood pressure, both measured with a strain-gauge, and with the skin perfusion pressure on the forefoot measured with the isotope washout technique. In 85 out of 134 legs (63 per cent) the amputation healed. The frequency of healing correlated statistically significantly with all three measures of distal blood pressures, the closest correlation being with the systolic digital blood pressure (SDBP). As measured in 110 cases the healing rates were: SDBP less than 20 mm Hg: four out of 23; SDBP 20-29 mm Hg: 13 out of 22; SDBP greater than or equal to 30 mm Hg: 51 out of 65. Ankle pressures and skin perfusion pressures were less useful. Invasive infection was present in 40 out of 102 diabetic legs and, next to ischaemia, was the major determinant of the healing results.

Aged↗
PubMed1983

Skin perfusion pressure measured by isotope washout in legs with arterial occlusive disease. Evaluation of different tracers, comparison to segmental systolic pressure, angiography and transcutaneous oxygen tension and variations during changes in systemic blood pressure.

The skin perfusion pressure (SPP) measured as the isotope washout cessation external pressure is valuable in selection of major amputation level. Five methodological investigations important to clinical use were carried out: (1) In five normal legs and 10 legs with arterial occlusive disease (AOD), 131I- -antipyrine (131I- -a.p.) was compared to Na(131I-) and 99Tcm-pertechnetate (99Tcm). The average SPP by 131I- -a.p. and by 131I- were approximately equal, 57.0 mmHg (range 18-93) compared to 56.3 mmHg (range 13-88) (P greater than 0.1). The average SPP by 99Tcm was just slightly higher, 60.3 mmHg (range 18-98) (P less than 0.02). The average washout constant for the three different tracers were approximately equal and correlated statistically significant with the SPP; (2) In 59 legs with AOD, segmental SPP was compared to segmental systolic blood pressures on the thigh, calf, ankle and first digit (strain gauge technique). The two different methods correlated statistically significant at all four levels, but the systolic blood pressures were higher than the SPP in particular in diabetic legs; (3) Angiograms in 35 legs with AOD showed that the SPP on the ankle was only consistently decreased in legs with arterial occlusions at two levels or more; (4) In 47 legs with AOD, the SPP on the calf or on the thigh was compared with transcutaneously measured pO2. The two different methods correlated statistically significant, but the scatter was great; (5) During induced variations in systemic blood pressure in seven patients (12 legs with AOD), the segmental SPP and the segmental systolic blood pressure were found on average to vary in proportion with intra-arterial mean and systolic pressure respectively; however, this proportional relationship was not valid for the individual leg. It is concluded that 99Tcm is as suitable as the 131I- -labelled tracers in estimating the SPP. The SPP is significantly correlated to skin blood flow, to systolic blood pressure, to tc pO2 and to angiographic findings. Correction of SPP for systemic blood pressure changes can be made in proportion with the measured variations in systemic mean blood pressure, but only for groups of patients.

Angiography↗
PubMed1983

The healing of through-knee amputations in relation to skin perfusion pressure.

The healing in 20 through-knee amputations was compared with preoperatively measured skin perfusion pressure, determined as the minimal external pressure required to stop the washout of isotopes injected intradermally 10 cm distal to the knee joint. Out of 18 amputations with a skin perfusion pressure of above 20 mmHg only 2 failed to heal, whereas 2 out of 4 cases with skin perfusion pressure below 20 mmHg failed to heal. It is concluded that the through-knee amputation must be considered in cases where the circulation is borderline for healing in below-knee amputation.

Aged↗
PubMed1983

Effect of proline on arginine uptake and nitrogen metabolism of lactating goats.

The hypothesis that addition of proline may save dietary protein for milk production was tested by administration of proline to two goats through a duodenal cannula. Because proline is synthesized by the mammary gland in vitro from arginine, the effect of proline supplementation on arginine uptake by the gland was tested in vivo. Arginine uptake, calculated from arterio-venous difference, dropped significantly in both animals, especially in the morning 1 h after milking, when a low-protein diet was fed. Milk production and total nitrogen in milk were not affected significantly by proline supplementation. A trend was toward decrease of milk orotic acid and an increase of milk fat due to proline supplementation.

Animals↗
PubMed1982

Level selection in leg amputation for arterial occlusive disease: a comparison of clinical evaluation and skin perfusion pressure.

In 102 leg amputations for arterial occlusion including 84 below-knee (BK), 16 above-knee (AD) and 2 through-knee (TK) amputations, the amputation level was determined by means of clinical criteria. The healing results and the selection of levels were then compared with sealed preoperative measurements of the skin perfusion pressure (SPP). Out of 62 BK amputations with an SPP above 30 mmHg wound healing failed in only 2 cases (3 per cent). Out of 13 BK amputations with an SPP between 20 and 30 mmHg 7 cases (54 per cent) failed and out of 9 BK amputations with an SPP below 20 mmHg no less than 8 cases (89 per cent) failed to heal. The difference in failure rate is significant (P less than 0.0001). Out of the 15 failed BK amputations at low pressures (below 30 mmHg) only one case had local signs of ischaemia, which might have warned the surgeons. On the other hand, in 13 out of the 18 cases of primary AK (or TK) amputations there were clinical signs of ischaemia of the calf, comprising temperature demarcation, cyanosis and/or necrotic skin lesion. The SPP below the knee appeared in all these cases to lie below 30 mmHg. In the 5 other cases of primary AK (or TK) amputation the knee was sacrificed for reasons other than signs of local ischaemia, e.g. poor physical or mental condition. It was moreover found that the presence of pulsations in the popliteal artery indicated an 89 per cent chance of healing of BK amputations. Infection was present in 24 BK amputations (28 per cent) and equally frequent among diabetic and non-diabetic cases. The postoperative SPP measured on the stumps averaged only 5 mmHg (P less than 0.05) higher than the preoperative SPP explaining why the preoperative SPP related closely to the postoperative course. It is concluded that ischaemia at the BK election site cannot be ruled out by clinical assessment alone and that preoperative determination of the SPP can be used in determining the chance of healing in BK amputations.

Aged↗
PubMed1980

Skin perfusion pressure on the legs measured as the external pressure required for skin reddening after blanching: a photo-electric technique compared to isotope washout.

The skin perfusion on the calf was measured photo-electrically and by isotope washout technique using external counter pressure by a blood pressure cuff. By the photocell the skin blanching threshold external pressure (BTEP) was recorded on histamine flared red skin. By isotope washout technique the skin blood flow cessation external pressure (FCEP) was recorded using intra-dermal [131I-]-antipyrine mixed with histamine in estimating the skin blood flow. The external pressure was measured with an airfilled plastic cushion connected to a mercury manometer. Over a wide range of pressures as obtained from twenty patients with occlusive arterial disease of the legs, five normal subjects and eleven patients treated for arterial hypertension the values of the two different methods were highly significantly correlated (r = 0.97, P < 0.001). On average the BTEP was equal to the FCEP: 83.9 mmHg (range 18-187) compared to 80.8 mmHg (range 18-158) (P > 0.1). A normal material was obtained from twenty-four subjects measured on the thigh, calf and ankle; the average gradients between the auscultatory brachial mean blood pressure and the BTEP were: thigh 10.7 mmHg (SD 12.7); calf 4.0 mmHg (SD 12.1); ankle 5.1 mmHg (SD 8.7). As compared to the intra-arterial blood pressure the BTEP was found to lie close to the mean blood pressure in normal subjects as well as in hypertensive subjects. The present data indicate that the skin perfusion pressure on the legs can be measured by the rapid photo-electric technique. The clinical application and sources of error are discussed.

Adult↗
PubMed1980

Ischaemic wound complications in above-knee amputations in relation to the skin perfusion pressure.

Healing of the stumps in 59 above-knee amputations was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I-(-) or 125I-(-) antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no fewer than 9 (82 per cent) suffered wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only 4 cases (8 per cent). The difference in wound complication rate is highly significant (P < 0.01). It is concluded that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations.

Adult↗
PubMed1980

Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease.

The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel (SPPH) as measured with a photocell. Thirty-two patients (35 feet with ulcerations) had diabetes mellitus. The treatment was conservative. In 42 feet the ulcers healed after an average period of 5.8 months; in 24 feet major amputation became necessary after an average of 4.3 months. The frequency of healing correlated significantly with the three distal blood pressure parameters investigated, the closest correlation being with the SDBP measured at the final examination, i.e. just after healing of the ulcer or just before an inevitable major amputation. Of the 22 cases with SDBP below 20 mmHg only two cases (9%) healed. Of the 11 cases with SDBP of 20 to 29 mmHg seven cases (64%) healed and of the 33 cases with SDBP of 30 mmHg or above all cases (100%) healed. There was no significant difference between the 35 diabetic feet and the 31 non-diabetic feet as regards the healing rates, although infection and peripheral neuropathy were frequent in the diabetic group. The data show that the systolic digital blood pressure is a particularly valuable prognostic parameter.

Adult↗
PubMed1979

On the pathogenesis of bedsores. Skin blood flow cessation by external pressure on the back.

This paper is devoted to elucidation of the question: Which external pressure is required to stop skin blood flow at the skin - support interface in humans lying on the back in the supine position? Cessation of blood flow was recorded as cessation of washout of an intracutaneous depot of 131I-antipyrine mixed with histamine. The external pressure was measured by a small airfilled plastic cushion connected to a mercury manometer. In 11 normal subjects, eight patients with hypertension and seven patients with tetra- or paraplegia the "flow cessation external pressure" (FCEP) was strongly correlated to the auscultatory brachial mean blood pressure (p less than or equal to 0.001). The difference mean blood pressure - FCEP was on average 4 mmHg (range (-11) - (+20) mmHg) and there was no significant difference between the three groups studied. Thus external pressure exceeding the actual mean blood pressure will stop skin circulation.

Adult↗
PubMed1979

Wound healing in below-knee amputations in relation to skin perfusion pressure.

In 60 below-knee amputations the healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I- or 125I--antipyrine mixed with histamine. Of the eight cases with an SPP below 20 mmHg, no less than six (75 per cent) failed to heal and required reamputation at the above-knee level. Of the 12 cases with an SPP between 20 and 30 mmHg four cases (33 per cent) failed to heal but of the 40 cases with an SPP above 30 mmHg, there were only four cases (10 per cent) which did not heal. The difference in failure rate is highly significant (P less than 0.01). Four out of 30 diabetic patients required reamputation as against 10 out of 30 non-diabetics (0.05 less than P less than 0.10). The average SPP was higher in the diabetic group: 57 mmHg (range 18-93 mmHg) compared with 34 mmHg (range 8-68 mmHg) in the non-diabetic group (P less than 0.001). The postoperative SPP measured on the stumps was on average 8 mmHg higher than the preoperative SPP (P less than 0.001). The increase took place mainly in stumps with an SPP above 20 mmHg explaining why the preoperative SPP values related so closely to the postoperative clinical course. We conclude that a low SPP can be used to predict ischaemic wound complications, leading to reamputation at a higher level.

Adult↗
PubMed1979

Wound healing in above-knee amputations in relation to skin perfusion pressure.

In 59 above-knee amputations healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 1318-- or 125I--antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no less than nine (82 per cent) suffered severe wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only four cases (8 per cent). The difference in wound complication rate is highly significant (P less than 0.01). The postoperative SPP measured on the stumps was on average only slightly and insignificantly higher than the preoperative values, explaining why the preoperative values related so closely to the postoperative clinical course. We conclude that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations.

Adult↗
PubMed1977

Skin perfusion pressure measured as the external pressure required to stop isotope washout. Methodological considerations and normal values on the legs.

The skin perfusion pressure was measured as the external pressure required to stop blood flow, as evidenced by cessation of the washout of an intracutaneous depot of [131I-]antipyrine mixed with histamine. The external pressure on the skin was measured by an 11 x 11 cm slack air-filled plastic cushion connected to a mercury manometer and interposed between the labelled area and a blood pressure cuff. The 'flow cessation external pressure' (FCEP) varied parallel to the intra-arterial femoral mean blood pressure, but was on the average 10.8 mmHg (SD 6.4) lower. FCEP was measured on twenty normal subjects at four different segments of the leg. The average differences between auscultatory brachial mean blood pressure and FCEP were: thigh 12.0 mmHg (SD 7.6); calf 10.4 mmHg (SD 7.4); ankle 12.9 mmHG (SD 10.1); foot 20.2 mmHg (SD 12.1). The SD of the difference between measurements on two different days, performed in forty-four patients with different degrees of occlusive arterial disease, varied between 5.6 and 8.3 mmHg at the different levels. The present data indicate that the skin perfusion pressure on the legs in normal subjects lies approximately 10 mmHg lower than the systemic mean arterial blood pressure.

Arterial Occlusive Diseases↗
PubMed1976

[Ambulatory psychotherapy at the medical department of a district policlinic].

From the psychotherapeutic unit of the department of internal diseases of a district outpatient department some experiences and recognitions are reported. The autogenic training and the group psychotherapy are the methodical centre. 200 non-selected psychotherapeutic cases are analysed with regard to sex, age, profession and diagnostics of the neurotic symptomatology.

Adult↗