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Biomedical subjects

P Sager

Publications and source records attributed to P Sager.

At least 37 records · Page 2Linked to original sources
PubMed1982

Femoral artery pressure measurement to predict the outcome of arterial surgery in patients with multilevel disease.

Direct measurement of the femoral artery pressure before operation has been used to predict the postoperative change in ankle and toe pressure in 102 limbs (83 patients) that underwent aortoiliac surgery for the treatment of atherosclerotic occlusion or stenosis affecting both the aortoiliac and femoral artery segments. Rest pain or gangrene was present in 74 limbs. In 26 other limbs simultaneous aortoiliac and femoral artery reconstructions were performed. The changes in both toe and ankle pressures could be confidently predicted from the preoperative data. A predicted toe pressure of lower than 25 mm Hg was associated with a high probability that amputation would be required. The chances of an amputation were less than 3% if a toe pressure higher than 40 mm Hg was predicted. If the predicted ankle pressure index was lower than 0.56, there was a 90% chance that intermittent claudication would persist. Measurement of the femoral artery pressure allows prediction of the toe and ankle pressure response to surgery to be made with sufficient accuracy to permit a preoperative decision to be made between the need for a single-level or a two-level arterial reconstruction: no patients who had an aortoiliac reconstruction needed a subsequent downstream repair of the femoral segment.

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PubMed1980

Classification of peripheral occlusive arterial diseases based on symptoms, signs and distal blood pressure measurements.

Systolic blood pressures at toe and ankle were measured in 459 consecutive patients with occlusive arterial disease. Fifty-eight per cent had intermittent claudication with arterial disease of all degrees of severity. Seventeen per cent complained of rest pain having toe systolic pressures below 30 mmHg, half had arterial lesions proximal to the groin. None had diabetes. Fourteen per cent non-diabetic patients had chronic ulcerations on the foot with arterial lesions similar to those in patients with rest pain. Eleven per cent diabetic patients with chronic ulcerations had less pronounced occlusive arterial disease which was located distally on the legs. A classification in three groups is suggested: (1) ischemia only during exercise; (2) ischemia at rest with or without ulcerations: and (3) diabetics with chronic ulcerations.

Adult↗
PubMed1980

Minimal distal pressure rise after reconstructive arterial surgery in patients with multiple obstructive arteriosclerosis.

Forty-one reconstructive procedures were carried out in thirty-five consecutive patients. Average age was 63 years (range 46-75). Thrombendarterectomy or by-pass procedures were carried out in twenty-nine proximal and twelve femoropopliteal reconstructions. Twenty-three patients had rest pain fifteen had ischemic ulcers. The preoperative median pressure index (per cent of arm systolic pressure) was 10% on the 1st toe. At the 10th postoperative day the median toe pressure rose to 25%. A further rise took place at the one month control to 30% which was unchanged throughout the study. All patients with a persistent postoperative toe pressure above 20% of arm systolic pressure were ultimately relieved from rest pain and chronic ulcers.

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↗
PubMed1978

Preoperative estimation of run off in patients with multiple level arterial obstructions as a guide to partial reconstructive surgery.

Preoperative measurements of direct femoral artery systolic pressure, indirect ankle systolic pressure and direct brachial artery systolic pressure were carried out in nine patients with severe ischemia and arterial occlusions both proximal and distal to the ingvinal ligament. The pressure-rise at the ankle was estimated preoperatively by assuming that the ankle pressure would rise in proportion to the rise in femoral artery pressure. Thus it was predicted that reconstruction of the iliac obstruction with aorta-femoral pressure gradients from 44 to 96 mm Hg would result in a rise in ankle pressure of 16--54 mm Hg. The actual rise in ankle pressure one month after reconstruction of the iliac arteries ranged from 10 to 46 mm Hg and was well correlated to the preoperative estimations. In conclusion, by proper pressure measurements the run-off problem of multiple level arterial occlusions can be evaluated. Thus the result of successful partial reconstruction can be assessed preoperatively.

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PubMed1978

Treatment of severe foot ischaemia by defibrination with ancrod: a randomized blind study.

Forty-two patients, mean age 68 years, with severe leg ischaemia were randomly treated with placebo or by controlled defibrination with ancrod for 3 weeks. Plasma fibrinogen concentration was kept at about 20% of normal in the ancrod treated group. The two groups proved to be well matched regarding factors which could affect the degree of ischaemia. Objective measurements showed a significant rise in ankle and toe systolic blood pressure in the ancrod group lasting for 3 months. There was no rise in distal blood pressure in the control group. In the ancrod treated group the toe and ankle systolic pressures rose about 8 mmHg, but this was not accompanied by an improvement in the clinical course.

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PubMed1976

Decompression with the aid of insoles in the treatment of diabetic neuropathic ulcers.

Thirty-seven out of 38 neuropathic ulcers in 21 diabetic patients healed during relief of external pressure obtained by properly fitted interchangeable insoles. The time required for healing was 1 to 12 months (mean 3.6 months). The presence of mild occlussive arterial disease did not influence the course of healing. Gross infection, which occurred in eight patients could be controlled by immobilization, antibiotics and, in the presence of pus, by radical surgical drainage.

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PubMed1975

Venous gangrene.

Venous gangrene is not a common disease. It develops as the extreme, irreversible phase of total thrombosis of the veins of an extremity. The literature is reviewed and 7 new cases are reported. Symptomatology, aetiology, pathogenesis and treatment are discussed. It is concluded that there is a significant causative relationship between malignant disease and venous gangrene.

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