Biomedical subjects

A M Wolthuis

Publications and source records attributed to A M Wolthuis.

6 recordsLinked to original sources

PubMed2006

Use of a pneumatic tourniquet improves outcome following trans-tibial amputation.

BACKGROUND: It is traditionally taught that a pneumatic tourniquet is contraindicated for trans-tibial amputations in patients with peripheral arterial disease. However, tourniquets are used successfully during total knee arthroplasty in elderly patients. Vascular patients undergoing a trans-tibial amputation have a high perioperative mortality and morbidity-notably the need for wound revision or a higher amputation level. We hypothesised that a tourniquet, used during amputation, would reduce blood loss and subsequent complications without compromising healing. METHODS: This was a prospective non-randomized study of 89 adult patients who underwent a trans-tibial amputation between January 2001 and December 2003. The endpoints were: haemoglobin levels, the need for blood transfusion, perioperative morbidity, revision rate and mortality. Patients were divided into two groups: a group with a pneumatic tourniquet (n=42) and a group without (n=47). RESULTS: The haemoglobin fall was 14.8% in the non-tourniquet group and 5.6% in the tourniquet group, with a higher need for transfusion in the non-tourniquet group. The revision rate was 14.3% in the tourniquet group and significantly higher in the non-tourniquet group (38.3%). Mortality was similar in both groups: 7.1% for the tourniquet and 6.4% for the non-tourniquet group. CONCLUSION: The use of a pneumatic tourniquet is safe and significantly reduces both blood loss and transfusion requirements during trans-tibial amputation. A pneumatic tourniquet reduces revision rates by over 50%, with subsequent cost savings.

Adult↗

PubMed2006

Complex iliac and bilateral common femoral artery aneurysms: a novel hybrid procedure.

A 74-year-old man presented with a right common iliac artery aneurysm and bilateral common femoral artery aneurysms. These aneurysms were repaired by a hybrid procedure. A one-stage approach was chosen including an endovascular stent-graft and femoro-iliaco-femoral Y-bypass grafting. The authors describe a novel combined open and endovascular approach to repair these complex aneurysms.

Aged↗

PubMed2005

[Trauma during pregnancy].

In the past 60 years trauma has become the most important cause of morbidity and mortality in pregnancy. Motor vehicle accidents are the most common cause of abdominal trauma and lead to the highest mortality. The typical anatomical and physiological changes occurring during pregnancy demand a specific resuscitation procedure in which stabilization of the mother hemodynamically has to be done first. During the secondary survey the mother and fetus have to be examined thoroughly. The correct use of safety belts is an essential part of prevention.

Female↗

PubMed2005

Complex thoracic aortic aneurysm: a combined open and endovascular approach.

The authors wish to describe a combined open and endovascular approach to repair a complex thoracic aortic aneurysm. A 72-year-old man with chronic obstructive pulmonary disease, aortic valvular insufficiency and diffuse thoracic aortic aneurysm underwent aortic valve and ascending aorta replacement by a Bentall-procedure and replacement of arch aneurysm using the elephant trunk technique, performed in a first procedure. During the second procedure, endovascular stenting of the descending thoracic aorta was done. Only a few similar case reports have been presented. Endovascular repair after an elephant trunk procedure for complex thoracic aortic aneurysms is an elegant approach to deal with such mega aortas. Further research is necessary to compare open and endovascular repair and to determine long-term follow-up with regard to endoleaks and mortality.

Aged↗

PubMed2003

Diaphragmatic endometriosis: diagnosis and surgical management--a case report.

Endometriosis has been observed in 8 to 15% of the women of reproductive age. Occasionally it can be found outside the pelvis, its usual location. Rather exceptionally it is located on the diaphragm. A case report of preoperatively diagnosed bilateral diaphragmatic endometriosis is presented and its surgical treatment will be discussed.

Adult↗

PubMedDate not supplied

Needle catheter jejunostomy complicated by pneumatosis intestinalis: a case report.

Needle catheter jejunostomy is a technique to allow enteral feeding after upper abdominal surgery. An unusual postoperative complication is pneumatosis intestinalis which can be life-threatening. A case of a 76-year-old man with pneumatosis intestinalis due to needle catheter jejunostomy, in whom diagnosis was made by CT-scan, is described. Needle catheter jejunostomy complicated by pneumatosis intestinalis needs attention and careful treatment. Removal of the catheter seems necessary, although controversy remains.

Aged↗