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Biomedical subjects

J A St Johnston

Publications and source records attributed to J A St Johnston.

3 recordsLinked to original sources
PubMed1994

Lower limb amputation: striking the balance.

During a 5-year period, 210 patients (125 male: aged 43-96 years, median 76 years) had 228 primary amputations for peripheral arterial disease. Level selection was by clinical criteria, and there were 148 below-knee (BK, 65%), 72 above-knee (AK, 32%) and eight Gritti-Stokes (GS, 3%). Revision was needed in 43 (19%). The 30-day mortality was 14%. There were 69 patients who had previously undergone bypass grafting (< 30 days in 36; 30 days-1 year 20; > 1 year 13). In these there were 57% BK and 43% AK with a revision rate of 13%--no worse than in patients who had not had attempted limb salvage. Decisions about rehabilitation were made by a team of doctors, nurses and therapists. The 69 patients fitted with prosthetic limbs between 1987 and 1990 were followed up for eventual mobility (minimum 6 months). Of these patients, 81% used their prosthesis at least around the house, but only 16% achieved near normal mobility. This series fails to support the claim that failed arterial bypass surgery prejudices amputation level or healing. Despite attempts to achieve a high rate of below-knee amputation and good rehabilitation, the revision rate remains high and really good prosthesis usage remains low in these elderly patients.

Adult↗
PubMedDate not supplied

Arterial embolectomy. A long-term perspective.

One hundred and thirteen elderly patients (median age 77 years, range 37-99) were followed up for 2-10.5 years after embolectomy in order to assess the late outcome. There were two groups of patients: those who had suffered an embolism (84) and those who in retrospect had thrombosis in situ (29). Thirty three of the embolus group (39%) died within 30 days of surgery, and factors associated with mortality (p less than 0.05) were age greater than 80 years, and failure to save the limb (17%). In the thrombosis group limb loss was more common (76%) and these patients also had a higher mortality (55%). Mean long term survival in the embolus group was 35 months (range 1-108 months) with a high mortality rate in the first 6 months after embolectomy and improved survival after this. There were no significant differences in mortality or cardiovascular events between the 27 patients on long term warfarin and the 19 patients not anticoagulated. Mortality after embolectomy is high but there remains a group of long term survivors. The value of oral anticoagulation for these patients remains unresolved.

Adult↗