PubMed Health⌕ Search

Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

At least 55 records · Page 3Linked to original sources
PubMed1998

Does renal failure influence infrainguinal bypass graft outcome?

The purpose of this study is to determine the role of renal failure (RF) in infrainguinal bypass graft outcome. From 1990 through 1996, 206 patients underwent 241 infrainguinal bypass grafts at two institutions. Thirty-three RF patients (42 bypasses) had a mean follow-up of 14.0 months and a mean age of 67.7 years, and 21 (64%) were male. Risk factors included hypertension (100%), diabetes (81.8%), and cardiac disease (75.8%). RF patients included 20 with end-stage renal disease (ESRD) and 14 with renal insufficiency (RI). One patient had RI during his first bypass and ESRD for his subsequent bypass. The major operative indication was limb salvage (90.5%). Total perioperative morbidity for ESRD was significantly higher than for RI and non-RF groups (P = 0.019). Early mortalities occurred in three ESRD, no RI, and seven non-RF patients. Life table analysis demonstrated no significant difference between primary patency (P = 0.56), secondary patency (P = 0.96), and limb salvage (P = 0.69) between ESRD and non-RF groups. However, there was an overall decreased survival rate in the ESRD group (P < 0.01). In conclusion, infrainguinal vein bypass grafting can be successfully performed in RF patients with comparable patency and limb salvage rates and therefore improve quality of life. However, perioperative morbidity was higher in ESRD and survival was significantly shorter for RF than for non-RF patients.

Aged↗
PubMed1998

Sociology of care in patients with severe peripheral vascular disease.

Peripheral vascular disease (PVD) remains a leading cause of limb amputation, resulting in a significant morbidity and disability. This study was undertaken to evaluate whether earlier referral of the patients with severe limb-threatening PVD to a vascular surgeon could result in a higher limb-salvage rate. Seventy-one consecutive patients, 48 men and 23 women, with mean ages of 67.1 and 70.4 years, respectively, were studied; there were 64 blacks (42 men, 22 women). Risk factors included smoking (39 men, 20 women) and diabetes mellitus (31 men, 11 women). The delay in seeking medical attention in patients with rest pain was 9 to 24 weeks (mean, 14.2), and with nonhealing ulcers the delay was 4 to 20 weeks (mean, 6.7). An additional delay of 11.7 weeks was noted if the patient was seen by a primary-care physician, and only 4 weeks if the patient was seen in the Emergency Department. Ten primary amputations were performed; 61 patients underwent limb-salvaging revascularization procedures, with a success rate of 87 per cent; 8 patients had below-the-knee amputation as a result of failed bypass. Delay in referral of patients with severe PVD can cause an increase in limb loss.

Black or African American↗
PubMed1998

Sequential biannual prevalence studies of pressure ulcers at Allegheny-Hahnemann University Hospital.

To assess the prevalence, documentation and care of pressure ulcers, and the effect of teaching and prevention strategies in a 750-bed university hospital, one-day studies were conducted in 1993, 1995, and 1997. Data gathered was used to evaluate areas in need of improvement and find cost-effective ways to reduce the prevalence of pressure ulcers. The overall prevalence of ulcers decreased from 18 percent in 1993 to 10 percent in 1995 and 1997. The prevalence of nosocomial ulcers decreased from 14 percent in 1993 to 8 percent in 1995 and 6 percent in 1997. The number of nutritional consults increased from 54 percent in 1993 to 67 percent in 1997, and more than half of all patients tested had serum albumin levels < 3.5 mg/dL. Skin assessments upon admission were completed in the majority of patients. While ulcer documentation was less than adequate for the majority of patients in 1993 and 1997, care measures, e.g., placement of patients on specialty beds or mattresses and use of dressings that provide a moist environment, improved considerably. The results of this study indicate that system-wide educational efforts aimed at all levels of patient care providers, and multi-specialty prevention and care efforts can reduce the prevalence of pressure ulcers.

Adult↗
PubMed1998

Improved coordination: the wound care specialist.

Optimal, cost-effective patient care requires the integration of research findings into practice and a continuing assessment of outcomes attained, which cannot be achieved unless care is continuous and multidisciplinary. Well-defined requirements for the education of an advanced practice nurse results in quality and effective wound-care delivery in a cost-effective fashion. The concerns of business and health must be blended to achieve optimal patient care.

Cost-Benefit Analysis↗
PubMed1998

Wound infection: a physician's perspective.

Infection in a wound represents a colony count of 10(5) or greater. Contamination is the presence of many surface organisms. Moist wound healing, not dehydration, protects and prepares the wound for coverage and closure. Relief of pain is a critical factor in achieving healing: a biological or pharmaceutical device can achieve protection and facilitate healing.

Debridement↗
PubMed1998

Epidemiology, risk factors, and management of peripheral vascular disease.

Peripheral vascular occlusive disease is initiated with a genetic risk factor component compounded by patient-controlled contributions including obesity, diabetes, hypertension, and smoking. Medical management of these factors may delay or obviate surgical intervention. Angiography may be used to perform angioplasty (+/- stents) or to guide various interventional procedures. The major contribution to pre- and post-operative assessment is the noninvasive laboratory.

Angioplasty↗
PubMed1997

Toe amputation in the diabetic patient.

BACKGROUND: We considered whether it is more practical to amputate the toe of a diabetic patient with osteomyelitis and good circulation or to treat the patient with antibiotics for a prolonged period. METHODS: We undertook a retrospective study of 141 diabetic patients who had undergone a toe-ray amputation for proven or documented osteomyelitis. RESULTS: The mean ankle/brachial index of all patients was 0.81 (range, 0.68 to 1.14); the mean functional days lost on antibiotic therapy was 39 (range, 7 to 84 days). The cost of 6 to 8 weeks of preoperative antibiotic therapy was $900 to $2240 (mean, $1440). CONCLUSIONS: Diabetic patients with good circulation and osteomyelitis of the toe may benefit from prompt toe amputation.

Amputation, Surgical↗
PubMed1997

Safety of carotid endarterectomy associated with small intracranial aneurysms.

BACKGROUND: The incidence and outcome of combined carotid artery disease and intracranial aneurysm (ICA) are not well reported. METHODS: Ten patients with combined disease, ICA and symptomatic carotid artery disease, were identified in 209 consecutive angiograms. Five men and five women with a mean age of 68 years and the risk factors of diabetes, hypertension, smoking, cardiac disease, peripheral vascular disease, and hypercholesterolemia formed the basis for this study. RESULTS: Five patients with carotid endarterectomy (CEA) and arterial aneurysms less than 5 mm and five with carotid stenosis and ICA less than 6 mm were treated with Coumadin; one with combined disease left the hospital without treatment; and one with combined disease died preoperatively of a myocardial infarction. One patient with a 2 cm x 3 cm ICA and carotid had both operated on successfully. CONCLUSIONS: In this group of patients, CEAs were done safely in patients with ICAs less than 6 mm.

Aged↗
PubMed1997

Blood dyscrasias and leg ulcers.

Despite a seemingly increased knowledge about the underlying causes of chronic leg ulcers, their management remains a challenge. Though some ulcers respond to various local treatment options appropriately, others seem to remain unresolved or with a chronic recurrent theme over months to years. The failure to heal these ulcers can be related to the underlying disease process, sometimes lack of patient compliance, and possibly, less than optimal treatment. Even when the exact diagnosis is made and appropriate treatment instituted, many ulcers may, nonetheless, require months of intervention. Certainly, the nonresponsive ulcer is best managed by an appropriate wound biopsy and culture, including a colony count.

Journal Article↗
PubMed1997

Value of the multi-service casualty processing unit in Operation Desert Storm: teamwork and flexibility.

This paper examines the role and implementation of a casualty processing unit (CPU) developed by a multi-service group during Operation Desert Storm in Saudi Arabia. Data were obtained from review of flight manifests, fleet hospital admission records, 24-hour follow-up of patients admitted to Fleet Hospital 15, and patient chart reviews following Desert Storm. The data indicate the CPU proved to be an effective and practical approach to health care in a combat zone, and provided an increased number of returned-to-duty personnel and timely triage of most seriously wounded combatants. In addition, it provided an opportunity for medical personnel of all branches of the armed services to participate as a team. As a result of this study, we propose consideration be given to use of this type of multi-service facility in future combat arenas.

Humans↗
PubMed1997

Pressure ulcers: collaboration in wound care. Is there a reasonable approach?

Pressure ulcers represent a significant impact on utilization of healthcare beds, cost for the insurer, and adverse emotional impact for the family. With this in mind, one must address in an effective fashion a method of objective assessment using the current methodology to deal with risk factors in mobility, disease states, and nutrition, as well as give significant attention to prevention protocols. One should adhere to a schedule of turning the patient, sleep surfaces, and appropriate skin care while recognizing the impact of each. Finally, treatment modalities should be undertaken, not only with cost-effective issues in mind, but with ease and convenience for the healthcare provider and the least discomfort for the patient as well. One can focus on debridement by way of enzymatic, autolytic, or surgical methods, recognizing surgery as the least effective for our goals in the management of this patient. Assessment and, finally, reassessment using the available scales will allow us to provide effective healthcare in a therapeutic fashion.

Beds↗
PubMed1996

Injury of a medial sacral vessel during lumbar laminectomy.

Vascular injury sustained during neurosurgical procedures is surprisingly rare, especially considering the anatomic proximity of major blood vessels to the vertebral column. Mortality rates are high if the injury is not recognized and definitive management is delayed. Case reports include massive hemorrhage, arteriovenous fistulas, and development of false aneurysms. Diagnostic CT scan and arteriography are useful if the patient's condition permits; however, rapid intervention is crucial to the patient's survival. After reviewing the current surgical literature, we present a case of medial sacral artery injury occurring during laminectomy.

Adult↗
PubMed1996

Thrombolysis theraphy in patients with femoropopliteal synthetic graft occulsions.

BACKGROUND: The aim of this study was to evaluate the efficiency of thrombolysis in the presence of an occluded femoropopliteal synthetic graft. PATIENTS AND METHODS: Over a 3-year period, 46 occluded femoropopliteral grafts were treated with urokinase and reconstruction. The cases were divided into three groups: group 1 (n=25), complete thrombolysis followed by reconstruction or angioplasty or both; group 2 (n=5), complete thrombolysis alone; and group 3 (n=16), failure of thrombolysis requiring reconstruction or leading to amputation. Patients were completely observed after treatment for more than 1 year. RESULTS: There are no fatal complications among patients with thrombolytic therapy. In group 1, the 3-year patency rates were 12% and the 3-year limb salvage rates were 77%. In group 2, the 3-year patency rates and the limb salvage rates were 20% and 80%, respectively. The group 3 patency rates and the limb salvage were 8% and 40%, respectively. The best results were achieved in patients who had thrombolysis followed by reconstruction (group 1) and in those who had thrombolysis alone (group 2). limb salvage was poor in patients with failure of lytic therapy regardless of the reconstruction (P<0.01). CONCLUSION: The use of intra-arterial urokinase followed by secondary vascular reconstructive procedures was studied. The patient with synthetic graft occlusion still has a reasonably favorable prognosis for long-term limb salvage when thrombolysis is successful.

Aged↗
PubMed1996

Penetrating cardiac injuries.

Penetrating cardiac injuries pose a tremendous challenge to any trauma surgeon. Time, sound judgment, aggressive intervention, and surgical technique are the most important factors contributing to positive outcomes. This article extensively reviews the history, surgical management, and techniques needed to deal with these critical injuries. This year commemorates the one hundredth anniversary of the first successful repair of a cardiac injury.

Animals↗
PubMed1996

Popliteal artery injury after total knee arthroplasty.

Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure. The incidence of vascular complications after TKA is low. However, these complications may be debilitating, limb-threatening, and potentially avoidable. Our first patient, who had no preexisting vascular occlusive disease, developed an ischemic extremity after TKA. The second patient underwent TKA and was diagnosed with a severely ischemic limb 48 hours postoperatively. Both patients underwent above-knee to below-knee popliteal artery saphenous vein bypass grafting. Although limb salvage was obtained in both cases, one had a significantly neuropathic foot. In conclusion, long-term morbidity can be avoided by early identification and treatment of ischemia by bypass grafting.

Aged↗
PubMed1996

Moist wound healing.

The optimum wound environment to enhance wound healing is a balance of nutrition, hypoxia, and removal of debris in an occlusive moist environment. With increasing knowledge of the healing process and the variety of dressings available, the end result of any wound management will be an expedited wound healing with maximum patient comfort.

Alginates↗
PubMed1996

Abdominal aortic aneurysectomy after kidney transplantation: case report and review of the literature.

Abdominal aortic aneurysms have been a rare finding in patients who have previously undergone renal transplantation. Previous operative strategies attempting to provide renal allograft protection during aortic cross-clamping have included extra-anatomic permanent as well as temporary bypass, heparin bonded shunts, in situ perfusion cooling of the allograft, and general hypothermia. These maneuvers, although generally successful, have recently been challenged by reports describing no specific protective measures. A case of a 5.0 cm but rapidly expanding abdominal aortic aneurysm in a patient who had undergone a prior successful kidney transplant is presented along with a literature review of 27 available cases on the subject.

Aortic Aneurysm, Abdominal↗