scholarly journals A Study on Bypass Surgery and Subsequent Wound Care for Ischemic Limbs Classified as Fontaine Stage IV and the Influence of the Level of Amputation on Walking Function

2012 ◽  
Vol 52 (November) ◽  
pp. 343-348
Author(s):  
Ikuro Kitano ◽  
Yoshihiko Tsuji ◽  
Koji Sugimoto
Keyword(s):  
Bypass Surgery ◽  
Wound Care ◽  
Stage Iv ◽  
Fontaine Stage Iv ◽  
Fontaine Stage

scholarly journals Prospective study on clinical characteristics of Japanese diabetic patients with chronic limb-threatening ischemia presenting Fontaine stage IV

2019 ◽  
Vol 11 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Mitsuyoshi Takahara ◽  
Shota Okuno ◽  
Izumi Nakamura ◽  
Osamu Iida ◽  
Takuya Tsujimura ◽  
...  
Keyword(s):  
Prospective Study ◽  
Clinical Characteristics ◽  
Stage Iv ◽  
Diabetic Patients ◽  
Fontaine Stage Iv ◽  
Fontaine Stage

scholarly journals Prevalence of asymptomatic carotid artery stenosis in Chinese patients with lower extremity peripheral arterial disease: a cross-sectional study on 653 patients

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042926
Author(s):  
Zhui Li ◽  
Hong Yang ◽  
Wenfang Zhang ◽  
Jing Wang ◽  
Yu Zhao ◽  
...  
Keyword(s):  
Stage Iv ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Chinese Patients ◽  
Total Occlusion ◽  
Cross Sectional ◽  
Asymptomatic Carotid Artery Stenosis ◽  
Fontaine Stage Iv ◽  
Peripheral Arterial ◽  
Fontaine Stage

ObjectiveThis study aimed to investigate the prevalence and identify predictive factors of asymptomatic carotid artery stenosis (ACAS) in Southern Chinese patients with peripheral arterial disease (PAD).DesignA cross-sectional study.Setting and participantsA total of 653 patients with PAD admitted to the First Affiliated Hospital of Chongqing Medical University from July 2014 to July 2019.Main outcome measuresThe degree of carotid stenosis was assessed by Duplex ultrasound and classified as normal (no stenosis), mild (<50% stenosis), moderate (50%–69% stenosis), severe (≥70% stenosis or near occlusion) and total occlusion. Patients with stenosis ≥50% were classified as having significant ACAS. Multivariable logistic regression analysis was used to calculate the risk associated with concomitant factors of ACAS.ResultsThe mean age was 71.5±5.5 years, and 55.9% of the patients were men. Significant ACAS stenosis accounted for 128 (19.6%) cases, including 68 (10.4%) cases of moderate stenosis (50%–69%), 46 (7.0%) cases of severe stenosis (70%–99%) and 14 (2.1%) cases of total occlusion. Multivariable analysis revealed that age ≥70 years (OR 2.0, 95% CI 1.25 to 3.18), an ankle brachial index (ABI) ≤0.5 (OR 3.39, 95% CI 1.34 to 8.55), an ABI ≤0.4 (OR 3.86, 95% CI 1.47 to 10.06) and Fontaine stage IV (OR 4.53, 95% CI 1.47 to 13.88) are predictive factors of significant ACAS.ConclusionThe prevalence of significant ACAS (stenosis ≥50%) in patients with PAD was approximately 19.6%. Significant ACAS was more common in patients with PAD older than 70 years, particularly in patients with an ABI <0.5 and those classified as Fontaine stage IV. Selective carotid screening may be more worthwhile in these high-risk patients with PAD.

Hyperbaric Oxygen Therapy in the Treatment of Fontaine Stage IV Thromboangiitis Obliterans

2016 ◽  
Vol 15 (4) ◽  
pp. 366-370
Author(s):  
Dogus Hemsinli ◽  
Safiye Tuba Kaplan ◽  
Sahin Kaplan ◽  
Furkan Yildirim
Keyword(s):  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Standard Treatment ◽  
Stage Iv ◽  
Thromboangiitis Obliterans ◽  
Number Of Patients ◽  
Fontaine Stage Iv ◽  
Fontaine Stage

Ischemic wounds unresponsive to standard treatment in thromboangiitis obliterans are associated with amputation, morbidity, and mortality. In this study, hyperbaric oxygen therapy was added to standard treatment of 36 patients with thromboangiitis obliterans with ischemic ulcerated wounds in the extremities. Full recovery was observed in 52.7% of cases (25% at discharge, 27.7% during follow-up). Resting pain after treatment decreased significantly compared to pretreatment levels based on visual analog scale scores (7.1 ± 1.7 vs 2.2 ± 3.0, P = .0001). Mean wound area also decreased significantly after treatment (22.6 ± 17.5 vs 13.02 ± 16.5, P = .0001). The number of patients requiring no assistance during routine daily activities increased significantly (25% vs 55.5%, P = .001). All patients were at Fontaine stage IV before hyperbaric oxygen therapy. The number of patients at stage IIB increased significantly after treatment, while that of patients at stage IV decreased significantly (0% vs 47.2%, P = .0001, and 100% vs 47.2%, P = .0001, respectively). None of our patients was able to walk without pain before treatment; however, walking distance was significantly extended in 16 patients who were capable of walking (0 vs 190.6 ± 129.4 meters, P = .0001). In addition, 11.1% of patients underwent major amputation during follow-up.

scholarly journals 1173. A Cluster of Carbapenemase-Producing Acinetobacter baumannii

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S354-S354
Author(s):  
Heather Young ◽  
Caroline Croyle ◽  
Sarah J Janelle ◽  
Bryan Knepper ◽  
Jennifer Kurtz ◽  
...  
Keyword(s):  
Public Health ◽  
Hand Hygiene ◽  
Wound Care ◽  
Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Stage Iv ◽  
Health Concern ◽  
Improve Hand Hygiene ◽  
Healthcare Facilities ◽  
Route Of Transmission

Abstract Background Carbapenem-resistant A. baumannii (CRAB) is reportable in Colorado with three to 11 cases detected annually. Between December 2017 and February 2018, Denver Health Medical Center (DHMC) detected two inpatients with CRAB in urine. The hospital and the Colorado Department of Public Health and Environment (CDPHE) conducted an investigation to determine epidemiologic links and molecular relatedness of the isolates. Methods We reviewed medical records and performed infection control observations among staff. Pulsed-field gel electrophoresis (PFGE) was performed at CDPHE; antimicrobial susceptibility (AST) and carbapenemase testing was performed at CDC. Results Epidemiologic investigation: Both patients had neurogenic bladders managed by suprapubic catheters, stage IV decubitus ulcers, and recent surgery. Neither had traveled outside of Colorado. Although both received recent antibiotics, neither received a carbapenem in the 6 previous months. Both isolates were regarded to be asymptomatic bacteriuria. In November 2017, the patients overlapped for 7 days at DHMC on different units. During this week, the same nurse provided wound care for both patients on the same day. Observations of the wound care team revealed opportunities to improve hand hygiene prior to donning and after doffing gloves, the use of single-use scissors on multiple patients, and inconsistent cleaning of a mobile device used to photograph wounds. Microbiologic and molecular investigations: Isolates from the two patients were indistinguishable by PFGE. AST found both isolates susceptible to colistin, but resistant to all other antimicrobials tested (Table 1); both harbored OXA-23-like genes by a Research Use Only assay performed at CDC. Conclusion These are the first carbapenemase-producing A. baumannii strains identified in Colorado. We suspect that they were transmitted during the overlapping hospital admission, although we could not determine where the organism originated or the route of transmission. Opportunities to improve hand hygiene and low-level disinfection were identified. The emergence of previously undetected carbapenemases in Colorado is of great public health concern; collaboration between public health and healthcare facilities is critical to halt transmission of novel regional pathogens. Disclosures All authors: No reported disclosures.

Is the revascularisation of pedal arteries worthwhile in diabetic gangrene?

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 34-39 ◽  
Author(s):  
Luther ◽  
Pillny ◽  
Müller ◽  
Lance ◽  
Sandmann
Keyword(s):  
Total Mortality ◽  
Stage Iv ◽  
Graft Patency ◽  
Diabetic Patients ◽  
Autologous Vein ◽  
Arterial Bypass Grafts ◽  
Foot Lesions ◽  
One Year ◽  
The One ◽  
Fontaine Stage Iv

The potential of arterial reconstructions at the foot level is a matter of debate. A series of 119 pedal arterial bypass grafts in 114 patients (77 diabetic and 37 non-diabetic patients, mean age 66 years) is reviewed retrospectively, after a mean follow-up 31 months. Of the patients, 91% had foot lesions regarded as Fontaine stage IV, and 97% had occlusions of all crural arteries with patent malleolar or pedal arteries. Autologous vein bypasses were grafted between pedal and either femoral (57%), popliteal (35%), or crural(8%) arteries. Results: the 30-day mortality was 4.4%, and the total mortality after 31 months was 21%. Postoperative graft failure resulted in 22 amputations above the ankle (in 12% of the diabetic, and in 32% of the nondiabetic patients). The one-year primary (secondary) graft patency rates were 67% (69%) in the diabetic patients, and 51% (59%) in the nondiabetic patients. Limb salvage rate was 82% (D) versus 62% (ND) after 1 year, and 64% (D) versus 55% (ND) after 31 months. Conclusion: nearly two thirds of diabetic patients with partial foot gangrene will benefit from timely pedal arterial reconstruction, and more than half of nondiabetic patients.

scholarly journals 1429. Diagnosis and Management of Osteomyelitis Associated with Stage IV Pressure Ulcers: Report of a Query to the Emerging Infections Network of the Infectious Diseases Society of America

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S521-S522
Author(s):  
Anjum S Kaka ◽  
Susan E Beekmann ◽  
Amy Gravely ◽  
Philip M Polgreen ◽  
James R Johnson
Keyword(s):  
Antimicrobial Therapy ◽  
Pressure Ulcers ◽  
Wound Care ◽  
Bone Biopsy ◽  
Stage Iv ◽  
Antibiotic Use ◽  
Future Research ◽  
Emerging Infections ◽  
Ulcer Base ◽  
Practice Variability

Abstract Background Despite the high prevalence and morbidity of stage IV pressure ulcers, there are few clinical studies to guide diagnosis and treatment of osteomyelitis in such patients. Methods The Emerging Infections Network conducted an electronic survey of adult ID physicians in 2018 to determine their approach to managing patients with stage IV pressure ulcers (exposed bone, tendon, or muscle) and osteomyelitis. Results The overall response rate was 42% (558/1,332). Of the respondents, 94/558 (17%) had not seen such patients in the last year, so opted out. Of the remaining 464 respondents, 276 (60%) usually felt confident in diagnosing osteomyelitis by physical examination, and laboratory or imaging test results; the strongest indicator of osteomyelitis was thought to be palpable or visible bone at the ulcer base (Figure 1). Approaches to diagnosing osteomyelitis in patients with visible and palpable bone varied: 41% would assume osteomyelitis was present, 27% would try local wound care and pressure-offloading before doing tests, 22% would do diagnostic tests immediately, and 10% would follow another strategy. The preferred tests for osteomyelitis were bone biopsy (for culture or histopathology) and MRI (Figure 2). Regarding treatment, respondents differed widely regarding favored route(s) of antimicrobial therapy (all IV, partly IV and partly oral, or all oral), regardless of presumed pathogen (Figure 3). Respondents also differed widely regarding preferred duration of antimicrobial therapy, but generally would treat longer in the absence of full surgical debridement (P < 0.001 overall) (Figure 4). Overall, 62% of respondents believed that osteomyelitis under stage IV pressure ulcers usually or almost always is treated excessively. Most respondents (59%) had multiple suggestions for future research, primarily regarding the duration and utility of antimicrobial therapy in this context. Conclusion ID physicians (i) report significant practice variability in their approach to diagnosing and treating osteomyelitis underlying stage IV pressure ulcers, (ii) are concerned about excessive antibiotic use in such patients, and (iii) perceive a critical need for additional research in this area. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document