Biomedical subjects

J P van der Plas

Publications and source records attributed to J P van der Plas.

3 recordsLinked to original sources

PubMed1998

[Benign paroxysmal positional vertigo].

Benign paroxysmal positional vertigo is a common malfunction of the labyrinth, most frequently of the posterior canal, due to clot of debris in the endolymph. The attacks of vertigo are characterised by dependency on position, latency after positioning of the head, short duration, nystagmus, reversibility and fatiguableness. The diagnosis can be based on history, physical examination and provocative tilting of the head as described by Dix and Hallpike. In a typical case further investigations are not necessary. The symptoms often improve spontaneously. Half of the patients can be cured directly by stepwise tilting. This probably removes the clot from the canal of the labyrinth to the utriculus. Specific positional exercises also often have a good result, but not as quickly. Drug therapy has no place in the treatment.

Cerebellar Diseases↗

PubMed1993

Isolated profundaplasty in critical limb ischaemia--still of any use?

Because of the improved quality of peripheral bypass surgery, the role of isolated profundaplasty in revascularisation of the critically ischaemic limb has become very limited. This retrospective study of 72 isolated profundaplasties performed for critical limb ischaemia revealed a clinical improvement 1 year postoperatively of 39% in the period 1978-1983 and of only 9% between 1984-1990. In the total period, patient survival after 1 year was 81% and limb salvage 60%. Clinical, haemodynamic and arteriographic parameters were analysed for their predictive value of clinical success. The presence of tissue necrosis or ulceration (clinical stage IV) affected clinical outcome negatively (p < 0.05). Risk factors and indicators for arteriosclerotic disease, age of the patient and ankle-brachial systolic pressure index (ABI) had no significant predictive value. Evaluation of the preoperative arteriographies revealed that only the aspect of the profunda femoris artery beyond its orifice was of significance: there was a strong relationship between the absence of obstructive disease in this part of the artery and clinical improvement (p < 0.005). These two significant parameters may be guidelines when considering an isolated profundaplasty as an alternative in the treatment of critical limb ischaemia. However, in the presence of other treatment possibilities nowadays, especially bypass surgery, the procedure appears to offer a very poor success rate.

Aged↗

PubMed1993

Factors determining the outcome of crural and pedal revascularisation for critical limb ischaemia.

The influences of clinical factors, site of distal anastomosis, type of graft and angiographic run-off, on graft patency and limb salvage following 141 femorocrural and pedal bypasses in 121 patients were investigated retrospectively. The grafts consisted of 111 femorocrural and 30 pedal bypasses; 49% of the patients had diabetes mellitus. Venous grafts were implanted in 116 limbs, using either in situ vein (65), reversed vein (38) or composite vein (13) graft. Twenty-five prosthetic grafts (14 PTFE and 11 umbilical veins) were inserted. After 1, 2, 3 and 4 years of follow-up, the primary cumulative patency rates for all grafts were respectively 67, 61, 55 and 55%, and the secondary patency rates were 75, 70, 64 and 64%. The site of distal anastomosis had no influence on graft patency rate; neither was there any significant effect of clinical risk factors and run-off on graft patency. Prosthetic grafts showed significantly lower patencies compared to venous grafts and appeared to be the only independent prognostic risk factor for graft failure (multivariate analysis; p = 0.03). Overall limb salvage rate was 84% at 3 years. There were four amputations with patent grafts. The limb salvage rates for in situ vein, reversed/composite vein and prosthetic grafts were 89, 79 and 66% at 3 years, respectively. Various bypass grafts to the crural and pedal arteries are successful and durable. The use of prosthetic grafts results in significantly lower patency rates, but appears to be effective for limb salvage.

Adult↗