J Formos Med Assoc
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This study evaluates the prognostic factors and causes associated with mortality in Chinese diabetic patients after lower extremity amputations. Medical records of all diabetic patients admitted to the National Taiwan University Hospital for leg amputations from 1982 to 1991 were reviewed. Demographic data, medical history, amputation levels and admission routines, including fasting plasma glucose, cholesterol, triglycerides, blood urea nitrogen, creatinine, urine protein and electrocardiograms, and bacterial culture done during the admission period were recorded. ⋯ A history of hypertension and coronary heart disease were found to be the best indicators for predicting a fatal outcome with rate ratios of over two-fold. This study shows that post-amputational mortality is high in diabetic patients and that the major cause of death is cerebral infarction. The major cause of death in this study differs from that reported for Caucasians, for whom cardiovascular disease is the most important cause of death.
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Determination of the level of amputation of an ischemic lower limb presents a difficult problem. This prospective study evaluated parameter capable of predicting wound healing in patients with peripheral vascular disease. Forty-four amputations performed on 38 patients for advanced ischemia of a lower extremity were analyzed. ⋯ However, ankle segmental pressure was not associated with the outcome of wound healing in the amputations distal to the ankle joint. The absolute skin temperature and the difference between the skin and ambient temperature were found to be poor predictors for wound healing. No significant differences were detected among the successes and failures with regard to the patient's sex, age, blood chemistry and duration of diabetes mellitus.