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Biomedical subjects

L P Jensen

Publications and source records attributed to L P Jensen.

At least 19 recordsLinked to original sources
PubMed2004

Accuracy of clinical data in a population based vascular registry.

INTRODUCTION: Clinical databases are increasingly being employed to evaluate the quality of treatments, including patients with peripheral vascular disease. Valid data is vital to the value of these analyses. OBJECTIVE: To assess the validity of clinical data in a population-based national vascular registry. DESIGN: Traditional reproducibility study was supplemented by refilling of data by an independent observer, thereby creating three data sets for comparison. MATERIALS AND METHODS: Twenty prospectively recorded electronic forms from each department were selected randomly from the Danish National Vascular Registry. Data forms were refilled by the surgeons of the department concerned, and by an independent member of the board of the Danish National Vascular Registry. Refilling was performed blinded to the original forms. CONCLUSIONS: A high degree of accuracy of clinical data can be achieved. An independent observer makes it possible to evaluate the classification of observer dependent parameters and explain differences in the reproducibility of data.

Databases, Factual↗
PubMed1998

Intermittent claudication. Conservative treatment, endovascular repair or open surgery for femoropopliteal disease.

Intermittent claudication (IC) has a prevalence of 5-10% in the population above 70 years old. 50-75% remains stable without treatment, and the amputation risk is approximately 1% a year. The most important risk factor is smoking, and cessation can lead to an improvement of 50% in walking distance. An exercise program for 3 to 6 months is associated with a significant improvement in walking distance in the order of 100% in the majority of patients. Also pharmacological treatment and weight loss can be of benefit. Endovascular repair in the femoropopliteal segment is associated with a high initial success rate of 90%, in case of lesions shorter than 5-10 cm. The long-term success is in accordance with the results after conservative treatment, with improvement in 50-60% of the patients. Infrainguinal bypass surgery has an initial success rate near to 90%, and a favourable long-term patency of 50-80%. Vein should be preferred in the below knee bypass. The surgical treatment carries an early mortality of 1% and an amputation rate similar to the untreated patients. In the treatment of IC, conservative treatment with cessation of smoking, physical exercise and risk reduction still is the method of choice. In selected cases with suitable lesions, PTA is a minimal invasive method, with a high short-term success rate, acceptable long-term success and low morbidity. In cases of disabling claudication, with a severe influence on working ability and/or social life, PTA or surgery should be offered to the well-informed patient, who is accepting the risks associated. Further refinement of the available methods, including enhancements in medical treatment, will undoubtedly in the future lead to a more active approach towards treatment of intermittent claudication.

Adult↗
PubMed1997

[Vena saphena magna in situ bypass to the ankel and foot. A prospective assessment of results of 101 procedures in 94 patients with threatening amputation].

The results of 101 in situ by-pass operations to the ankle and foot are given. Seventy-five percent of the patients had other arteriosclerotic manifestations and 55% were diabetics. Ninety-nine percent of the operations were limb salvage surgery. The accumulative secondary patency rate was 87% after one month and 65% after three years. The results did not differ from by-pass surgery to the crural arteries. The wound complication rate was 16% with an infection rate of 7% and the major amputation rate was 8% after one month and 10% after three years. The survival of this selected group of patients was lower than a group of sex- and age-matched controls. The long term results of this type of advanced by-pass surgery in limb threatening ischaemia are very satisfactory and should be a must in every vascular surgeon's armamentarium.

Aged↗
PubMed1997

Early vein bypass thrombectomy is associated with an increased risk of graft related stenoses.

OBJECTIVES: To assess the risk of graft stenoses following early thrombectomy of peripheral vein bypasses. DESIGN: Prospective study of 371 vein bypasses performed at the Vascular Service, Rigshospitalet, Copenhagen from January 1991 through December 1992. MATERIALS AND METHODS: Thirty-six vein bypasses reopened by thrombectomy within 30 days postoperatively (group I) and 335 bypasses not subjected to early thrombectomy (group II) were studied by ultrasound duplex scanning 3, 6, 9, 12, 18, 24, 36 and 48 months postoperatively. A localised increase in the peak systolic velocity of 250% or more was considered an indicator for significant stenosis. RESULTS: In the perioperative period nine (2%) patients died, 30 (8%) bypasses occluded and 14 (4%) patients were lost to follow-up. Among the 318 patients remaining at risk at 1 month graft stenoses were identified in 39% (9/23) in group I compared to 17% (51/295) in group II, p = 0.03. Late bypass revisions were required in 35% (8/23) in group I as opposed to 9% (28/295) in group II, p = 0.004. Despite this high number of revisional procedures the 12-months secondary bypass patency was lower in recanalised grafts (38% vs. 82%, p < 0.00001). CONCLUSION: Early vein bypass thrombectomy is associated with a two-fold increased risk of graft related stenoses and a reduced secondary bypass patency.

Adult↗
PubMed1997

Femoral pseudoaneurysms in drug addicts.

OBJECTIVE: To evaluate the outcome of treatment of femoral pseudoaneurysms in drug addicts. METHODS: The records of eight patients undergoing vascular surgery for femoral pseudoaneurysms from substance abuse identified from a vascular database were reviewed. RESULTS: Were good in four out of five patients who had a primary vascular reconstruction. Two out of two patients who had a triple ligation of their aneurysms had claudication postoperatively. One patient presenting with thrombosis had a hip-exarticulation following an unsuccessful thrombectomi. No death occurred in this series. CONCLUSION: Revascularisation at the time of resection of the pseudoaneurysm offers better prospects for limb function.

Adult↗
PubMed1996

The importance of complete follow-up for results after femoro-infrapopliteal vascular surgery.

OBJECTIVES: The aim of this study was to assess the reliability of patency rates calculated on basis of data from a standard vascular registry. DESIGN AND SETTING: Since 1989, all patients undergoing infrainguinal bypass procedures have been offered a standard follow-up programme at 3 month intervals and all data have been recorded prospectively in a vascular registry. As part of a randomised trial on adjuvant medication in femorocrural bypass surgery, 102 patients, operated on between 1990 and 1992 were independently and simultaneously monitored. This subgroup was examined at 3 and 12 months postoperatively and 100% follow-up was obtained. After completion of the trial we calculated the patency and survival rates using life-table methods and compared the results based on the vascular registry with those achieved in the clinical trial. RESULTS: Comparing the results from the two databases revealed a marked discrepancy between the calculated figures: primary (68% in the registry and 52% in the trial) and secondary patency rates (90% vs. 63%), limb survival (97% vs. 77% as well as patients survival rates (95% vs. 85%). The differences could be explained by a substantial number of patients being lost to follow-up according to the vascular registry database and the fact that these patients turned out to have a significantly increased rate of graft thrombosis, limb amputation and death, respectively. CONCLUSIONS: Life-table statistics may inadvertently become unreliable if a large proportion of patients is lost to follow-up, since failure to examine the patient for any reason may be related to the patients health. In addition to the number of patients at risk, it is suggested, that life-table plots should be supplemented with information on the number of patients lost to follow-up.

Amputation, Surgical↗
PubMed1995

[Laparoscopic cholecystectomy in Denmark. A prospective registration].

Laparoscopic cholecystectomy (LC) was introduced in Denmark in 1991, and a prospective case register was established. All departments performing LC agreed to participate. In 1991-1992, 2,415 patients underwent LC in 44 departments. The median number of procedures was 32 (interquartile range 18-58, range 1-370), performed by a median of four surgeons per department (3-5, 1-23). Two hundred and forty-two patients (10%) had acute cholecystitis. Eighteen point five percent had had an ERCP performed prior to LC. The rate of conversion to open operation was 10.5%, occurring significantly more often in acute cholecystitis (25.6%) than in patients with other indications (8.8%) (p < 0.001). Intraoperative cholangiography was used in 22.4%. The median duration of LC was 90 minutes (70-120, 25-415). The postoperative course was without complications in 90.4%. Laparotomy for complications was necessary in 43 patients (2.0%), mainly because of bile leaks. Twelve patients (0.6%) were treated endoscopically for complications. Bile duct injury occurred in 16 patients (0.66%, 95% CI 0.34-0.99%), including three transsections, one stricture, and 12 minor injuries. Six patients (0.25%, 95% CI 0-0.45%), three of whom had procedure-related complications, died postoperatively. All were > or = 72 years of age. Median time to discharge was two days, while median time to resumed work/normal activity was eight days. A comparison with the number of LC registered in the National Patient Register indicates that reporting is complete.

Adolescent↗
PubMed1995

[Quality of data on computerized registration of postoperative wound infections].

At the Department of General Surgery, Hillerød Hospital, the quality of data from a continuous registration of post-operative wound infection was evaluated. Data registered over a six-month period were compared with data available in caserecords and data from a questionnaire sent to the patients. During the period 1.2-31.7.1990 924 operations were registered in 864 patients. Eight hundred and ninety-five patient records could be traced and 770 questionnaires were sent. The remaining 125 were dead or had unknown addresses. Six hundred eighty-seven questionnaires were returned. The data-registered overall infection rate was 3.0%. The actual infection rate was 8.9%. Fifty-eight percent of the infections noted in the records were registered. Approximately 40% of the infections were diagnosed and treated in general practice only. It is concluded that in order to compare infection rates between departments, it is necessary to ensure that equal definitions and equal quality of the data are used. Strict routines in the department and a close contact to the general practitioners are essential to achieve a satisfactory quality of data.

Denmark↗
PubMed1995

Single layer colonic anastomosis with a continuous absorbable monofilament polyglyconate suture.

OBJECTIVE: To report our experience with a single layer continuous absorbable monofilament polyglyconate suture technique in colonic anastomosis. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark. SUBJECTS: 105 consecutive patients operated on electively during the period January 1987-June 1990. INTERVENTIONS: Single layer continuous monofilament polyglyconate end-to-end anastomosis. MAIN OUTCOME MEASURES: Clinical signs of anastomotic leak and stricture, wound infections, and duration of hospital stay postoperatively. RESULTS: Of the 105 patients in the study, 1 developed an anastomotic leak (1%, 95% confidence interval 0 to 5.2%). Median duration of hospital stay was 8 days (range 4-72) and wound infections were recorded in 7 patients (7%, 95% confidence interval 2.7 to 13.2%). None of the patients had symptoms of anastomotic stricture at follow-up (median 19 months, range 2-48). CONCLUSION: Single layered continuous colonic anastomosis with an absorbable monofilament suture is a safe technique, easily learned even by relatively inexperienced surgeons and less expensive than other methods.

Adolescent↗
PubMed1994

[4 years of experiences with Karbase. A tool for quality development in vascular surgery].

Karbase, a Danish register for vascular surgery is presented with data from four years experience. The register consists of 65 variables centered on risk factors, the perioperative course as well as follow-up information. During the four-year period 1989-1992 a total of 4902 admissions were registered in 3810 patients. Surgery was performed during 4005 admissions. Output data from Karbase is presented with results on survival and postoperative complications, related to preoperative risk factors. The incidence of surgical wound infections was 3.9%, with a significant reduction during the years (p = 0.004). Karbase is now used by all vascular surgical units in Denmark. We conclude that the establishment of a continuous registration has been beneficial to the department. We have achieved valid data on treatment, outcome and complications in relation to individual risk factors. In the future the use of Karbase will be extended with the aim of further quality development, locally as well as nation wide.

Denmark↗
PubMed1993

[In situ bypass and diabetes].

From 1986 through to 1990 a total of 483 in situ bypass procedures were performed in 444 patients. Preoperative risk-factors were equally distributed among diabetic (DM) and non-diabetic (NDM) patients, except for smoking habits (DM:48%, NDM:64%, p = 0.002) and cardiac disease (DM:45%, NDM:29%, p = 0.005). Critical limb-ischaemia was more often present in diabetic than non-diabetic patients (DM:57%, NDM:36%, p = 0.0002). Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.00001). There were no differences among diabetic and non-diabetic patients regarding three years primary and secondary patency (58% and 64% respectively), and regarding major amputations. However, the rate of minor amputations was higher in insulin-dependent compared with non-insulin-dependent diabetics, who in turn had a higher rate than non-diabetics (p < 0.00001). A markedly decreased survival rate was found in diabetics (p < 0.00005). We found the in situ bypass technique very useful in the treatment of critical ischaemia of the lower limb in diabetic patients. The overall results in diabetic patients, whether insulin-dependent or not, were equal to those in non-diabetic patients.

Adolescent↗
PubMed1993

Natural history of abdominal aortic aneurysm: a survey of 63 patients treated nonoperatively.

During a 10-year period in which 735 patients presented with abdominal aortic aneurysms to our clinic, 63 were not offered operative treatment. The primary reason for choosing conservative treatment was concomitant diseases that increased the risk of operation. After 2 years of followup, half of the patients died, and the cumulative 5-year survival rate was 15%. Aneurysm rupture was the primary cause of death. The cumulative 5-year mortality hazard rate from rupture was 0.36, corresponding to an annual risk of rupture of 7%. The cumulative 5-year hazard rate of death from all other causes was 1.53, corresponding to an annual risk of 30%. Diameter of the aneurysm was found to be the only factor with a significant impact on the rate of rupture. The cumulative 5-year hazard rate of rupture among patients with aneurysms < 6 cm and > or = 6 cm was 0.2 and 0.6, respectively, corresponding to an annual risk of rupture of less than 5% and 10% to 15%, respectively. However, neither diameter nor other risk factors had significant influence on the time of rupture. In our opinion, once the diagnosis is confirmed the patient should be offered aneurysm resection if the general health status permits anesthesia.

Aged↗
PubMed1993

Prevalence of infections and use of antibiotics among hospitalized patients in Mauritius. A nationwide survey for the planning of a national infection control programme.

As part of a programme for improving hospital infection control in Mauritius a nationwide survey, including a prevalence study, was carried out in order to identify characteristics of the hospitals, the population, and the infections. Community-acquired infections were three times more prevalent than nosocomial infections: 15.0% and 4.9%, respectively. Surgical wound infection was by far the most common nosocomial infection, with a prevalence rate of 8.2 per 100 operations, followed by urinary tract infection with a low rate of 0.8 per 100 admissions. The survey showed that these hospitals in Mauritius housed mainly a young population (mean of 36.8 years for females and 39.4 years for males) with few risk factors for acquiring nosocomial infection. Although diabetes mellitus is prevalent in Mauritius the diagnosis of diabetes was not associated with nosocomial infection. The spectrum of operations offered was limited, and Caesarean section was the most prevalent operation. The amount and types of antibiotics used in hospitalized patients were recorded. More than one third of the patients received antibiotic treatment at the time of the survey, which is comparable to figures reported from large teaching hospitals in Western Europe. The information gathered from the survey, the interviews and the inspection were used to establish priorities for a collaborative programme for improved infection control. It included the draft of a set of custom-made guidelines, which were eventually studied by staff members from hospitals in Mauritius during a training period in Denmark. We believe that a prevalence survey is useful for initiating infection control programmes in hospitals in developing countries.

Adult↗
PubMed1993

Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia.

In situ saphenous vein arterial bypass flow was studied in 16 patients with respect to level of epidural anaesthesia. Arterial pressure and electromagnetic flow were used to evaluate arterial tone by intra-arterial (i.a.) papaverine. Eight patients had a low epidural block (< or = Th. 10) and eight patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated during low epidural anaesthesia (P < 0.02). Increase in arterial flow after i.a. papaverine was not significantly different in patients operated in low epidural and general anaesthesia (n = 8). In eight patients with insulin-dependent diabetes mellitus who had low epidural anaesthesia, the increase in flow after i.a. papaverine was not significantly different to that noted during high epidural anaesthesia. The results indicate that the level of analgesia influences graft flow after i.a. papaverine, probably reflecting differences in the effect of epidural anaesthesia on sympathetic tone to the leg.

Adult↗