Relative mortality and long term survival for the non-diabetic lower limb amputee with vascular insufficiency.

On a well defined non-diabetic amputation group with vascular insufficiency consisting of 10,191 amputations during the period 1982 to 1992 the Standard Mortality Rate (SMR) and the long term survival (Kaplan-Meyer) were analysed. The SMR for the total group was 8.6 (8.4-8.9) times the expected mortality the first year after amputation, decreasing to 3.2 (3.3-3.4) the second year. SMR in relation to age, gender and level of amputation was analysed. In the long term survival studies the median survival time (50% survival) for the total group was 1.8 years. Significant relation was found between the long term survival and gender, age and level of amputation.

[Traumatic rhabdomyolysis. Physiopathology and treatment]. / Traumatisk rabdomyolyse. Patofysiologi og behandling.

Crush syndrome or traumatic rhabdomyolysis constitutes the systemic changes seen after crush injury, i.e. the damages seen after a prolonged period of pressure on a muscle group. The pressure causes necrosis of muscle, and during revascularisation diffusion of calcium, sodium and water into the damaged muscle cells is seen, together with loss of potassium, phosphate, lactic acid, myoglobin and creatinine kinase. Untreated these changes can lead to: hyperkalaemia, acidosis, acute renal failure and hypovolaemic shock. Treatment of the systemic changes should be initiated immediately, aiming at a rapid correction of the extracellular volume and forced mannitol-alkaline diuresis. If renal failure develops, haemodialysis is started. The crush injuries are treated conservatively without fasciotomy, despite high or increasing intracompartmental pressure. The only indications for fasciotomy are lack of a distal pulse or open lesions. If fasciotomy is performed, radical removal of all necrotic muscle is essential.

Major lower limb amputation in diabetic patients: development during 1982 to 1993.

This study analyses 2848 primary major lower limb amputations in diabetic individuals during the period 1982-1993. The male:female sex ratio (mean 1.18) increased, while the mean age at the primary amputation was constant (70.96 years) during the period. The incidence uniformly decreased for both men and women by 0.96 per year. A subdivision of the total population into three age groups (< 50, 50-70, > 70 years), shows a 0.95 decrease per year with no significant difference between the groups. The decrease in incidence during the period 1987-1993 appeared specifically related to insulin-dependent diabetes mellitus (0.92), whereas the incidence of amputations in non-insulin-dependent diabetic patients was constant. The overall decrease of incidence during the period (40%) does not fully meet the target specified in the St. Vincent Declaration.

Major upper extremity amputation in Denmark.

Upper extremity amputations in Denmark between 1978 and 1983 comprised 3 percent of all major amputations. Trauma was the main reason for upper extremity amputations.

The Danish Amputation Register 1972-1984.

The DAR was established in 1972 for the purpose of collecting data on major upper and lower extremity amputations as well as details on corresponding prosthetic fitting in Denmark. During phase 1 (1972-1980) voluntary reports were submitted by surgical departments and prosthetic manufacturers, totalling about 5000. During phase 2 (1978-1984) data on all amputations in Denmark were supplied on a yearly basis by the National Patient Register, a division of the National Health Board. The information collected during phase 1 is rather detailed, but does not represent the entire national output. The phase 2 data are less detailed, but yield full national coverage. The information is compatible as to distribution of age, sex and etiology. The methods and present status of data processing are described and the planning for the foreseeable future is outlined.

Choice of level in lower extremity amputation--nationwide survey.

This survey analyses the levels of all major lower limb amputations in Denmark performed in 1980. During that year a total of 2,404 amputations were carried out on 2,177 patients.

Prevention and treatment of ulcerations of the foot in unilaterally amputated diabetic patients.

In unilaterally amputated diabetic patients the prognosis for the remaining leg is poor. Often the patients suffer from diabetic neuropathy, angiopathy and/or arteriosclerosis. Furthermore, the load pattern of the remaining foot is frequently abnormal. In order to assess the extent of the problem, as well as the possibility of preventive care, 20 patients in the outpatient clinic of the Steno Memorial Hospital were followed for a period of 17 months. Eighteen patients showed signs of peripheral neuropathy and 19 an abnormal load pattern. Following preliminary assessment the dynamic load pattern of the ambulant patients was recorded and their shoes were fitted with a corrective insoles made of Rubazote. In the presence of ulcerations the insoles were continuously modified according to the diminishing size of the ulcer. Supplementary local dressing and systemic antibiotics were administered according to need. Initially 11 patients had pedal ulcerations, 5 ischemic and 6 neuropathic. All of the neuropathic ulcerations healed during the period of observation and no new ulcerations were seen. Two of the ischemic ulcerations healed whereas the remaining 3 persisted. It is concluded that regulation of the pedal load pattern in unilaterally amputated diabetic patients has a considerable curative and preventive effect.

Initial hospital care of the multitraumatized patient.

Efficient care of the multitraumatized patient in the emergency department is a most demanding task, to be carried out within narrow time limits. Efficient and successful execution can only be secured by team work, according to systematic and well rehearsed plans. The objectives are survival, stabilization, thorough diagnosis and establishment of priorities for definitive therapy. These objectives should be met within a period of 15 to 30 minutes.

Incidence of reamputation and death after gangrene of the lower extremity.

Since 1972 the Danish Amputation Register (DAR) has recorded major amputations in Denmark. The register is based on voluntary detailed reports from surgical and orthopaedic departments. The present investigation is based upon 2029 amputations for arteriosclerotic and diabetic gangrene with an observation period up to 4 years. The incidence of ipsilateral reamputation is high in the immediate postoperative period with 10.4% after one month, 16.5% after three months and 18.8% after six months. Later the incidence is quite low, reaching a total of 23.1% after four years. The risk of contralateral amputation is ever present with an incidence of 11.9% within one year, 17.8% after two years, 27.2% after three years, and finally 44.3% after four years. The mortality after three months is 16.3% and then tapers off to a total of 22.5% after four years. As compared with the normal population a significant over-mortality is seen during the first three months, and an equally significant under-mortality from six months onward during the observation period.