Current Indications for Surgical Treatment of Primary Hyperparathyroidism in the Elderly

2017 ◽  
Vol 83 (3) ◽  
pp. 296-302 ◽  
Author(s):  
Andrea Polistena ◽  
Roberta Lucchini ◽  
Massimo Monacelli ◽  
Roberta Triola ◽  
Stefano Avenia ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Recurrent Laryngeal Nerve Palsy ◽  
The Elderly ◽  
Mineral Density ◽  
Asymptomatic Patients ◽  
Group A ◽  
Surgery In The Elderly ◽  
One Year ◽  
Group B

This study presents the results of surgery in the elderly for primary hyperparathyroidism (PHPT) from a single institution's experience. We retrospectively analyzed 898 cases of surgically treated PHPT, divided into two groups: 135 elderly patients (A) and 763 patients younger than 65 years (B). PHPT was symptomatic in 68.8 per cent patients in group A and in 81.6 per cent in group B. Unilateral temporary recurrent laryngeal nerve palsy was observed in 0.9 per cent in group A and 0.1 per cent in group B (P > 0.05). No cervical hematomas, mortality or major cardiovascular, neurological, respiratory or metabolic postoperative complications were registered. All the patients evaluated at one year had improvement in the quality of life, with increase of bone mineral density (BMD) in 85.6 per cent and 79.8 per cent of patients in groups A and B, with no significant differences between symptomatic and asymptomatic patients. Parathyroidectomy in elderly PHPT patients is safe, with rate of morbidity similar to what observed in younger individuals. Further investigations are recommended to confirm the role of surgery as an effective approach in elderly PHPT patients.

scholarly journals Reduction of arrhythmias in primary hyperparathyroidism, by parathyroidectomy, evaluated with 24-h ECG monitoring

2018 ◽  
Vol 179 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Jessica Pepe ◽  
Cristiana Cipriani ◽  
Mario Curione ◽  
Federica Biamonte ◽  
Luciano Colangelo ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Mineral Metabolism ◽  
Randomized Study ◽  
Density Measurement ◽  
Mean Value ◽  
Ecg Monitoring ◽  
Mineral Density ◽  
Group A ◽  
Group B ◽  
The Impact

ObjectiveHypercalcemia may induce arrhythmias. There are no data on the prevalence of arrhythmias in primary hyperparathyroidism (PHPT) in daily life. Aim of the study was to investigate both the prevalence of arrhythmias in patients with PHPT compared to controls and the impact of parathyroidectomy, evaluated by 24-h electrocardiogram (ECG) monitoring.DesignThis is a randomized study.MethodsTwenty-six postmenopausal women with PHPT and 26 controls were enrolled. PHPT patients were randomized to two groups: 13 underwent parathyroidectomy (Group A) and 13 were followed up conservatively (Group B). After 6 months, patients were studied again. Each patient underwent mineral metabolism biochemical evaluation, bone mineral density measurement, standard ECG and 24-h ECG monitoring.ResultsPHPT patients showed higher calcium and parathyroid hormone compared to controls and a higher prevalence of both supraventricular (SVBPs) and ventricular premature beats (VPBs) during 24-h ECG monitoring. Groups A and B showed no differences in mean baseline biochemical values and ECG parameters. Mean value of QTc in PHPT groups was in the normal range at baseline, but significantly shorter than controls. A negative correlation was found between QTc and ionized calcium levels (r = −0.48,P < 0.05). After parathyroidectomy, Group A had a significant reduction in SVPBs and VPBs compared to baseline and restored normal QTc. Group B showed no significant changes after a 6-month period.ConclusionsThe increased prevalence of SVPBs and VPBs is significantly reduced by parathyroidectomy, and it is mainly related to the short QTc caused by hypercalcemia.

scholarly journals Evaluation of Bone Mineral Density in Subjects with Primary Hyperparathyroidism by Dual Energy X-Ray Absorptiometry

2018 ◽  
Vol 20 (2) ◽  
pp. 129
Author(s):  
Rezwana Haque ◽  
Raihan Hussain ◽  
Shamim MF Begum
Keyword(s):  
Bone Loss ◽  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Dual Energy ◽  
Mineral Density ◽  
X Ray ◽  
T Score ◽  
Group A ◽  
Group B ◽  
Bone Condition

<p><strong><em>Objective:</em></strong><strong> </strong>Bone loss is a major complication of primary hyperparathyroidism (PHPT), and the extent of bone loss is an important factor for parathyroidectomy. Studies focused on this issue of bone loss in subjects with PHPT are quite rare in our country. This study will help the physicians to take proper action by giving an exact reflection of bone condition in subjects with PHPT. The purpose of this study was to evaluate the bone condition by measuring Bone Mineral Density (BMD), in subjects with PHPT using Dual Energy X-ray Absorptiometry (DEXA) and compare these findings with individuals without PHPT.</p><p><strong><em>Patients and Methods:</em></strong><strong> </strong>It was an analytic cross sectional study (group comparison) carried out at National Institute of Nuclear Medicine and Allied Sciences (NINMAS) BSMMU campus, Dhaka from July 2015-December 2016. Subjects of PHPT diagnosed by biochemical evaluation (increased serum calcium and parathyroid hormone concentrations), between age ranges 15-45 years were selected as group-A. Individuals without biochemical evidence of PHPT or other major illness causing bone loss were selected as comparison group or as group-B. The subjects underwent BMD test by DEXA at lumbar spines from L1-L4 vertebra and the left femoral neck using Norland XR-46 densitometer. BMD was classified according to WHO criteria. Data presented on categorical form were analyzed using chi-squared test. While the data presented on continuous scale were analyzed using student’s t-test. In each analysis, level of significance was 5% and P value &lt;0.05 was considered significant. Data were processed and analyzed with the help of computer software SPSS, version 20.</p><p><strong><em>Results:</em></strong><strong> </strong>Total number of 90 subjects were selected for this study, 45 subjects with PHPT were in group-A and equal number of subjects without PHPT were in group-B. The findings derived from data analysis showed, a significantly more male participants in group-A. The mean age of group-A and group-B was 37.24 ± 8.03 years and 38.20 ± 5.74 years respectively. Mean BMI of group-A was 25.10 ± 4.35 kg/m<sup>2  </sup>in compare to 29.43 ± 5.17 kg/m<sup>2</sup> in group-B. Higher BMI was noted in both groups. PHPT subjects with high BMI had low BMD. BMD expressed in absolute value (gm/cm<sup>2</sup>) and T score. BMD was significantly low in group-A (with PHPT) than in group-B (without PHPT), (p&lt;0.0001). In group-A, prevalence of low BMD was 62.2% (osteopenia 37.8%  and osteoporosis 24.4%)  at lumbar spine and 84.5% (osteopenia 35.6% and osteoporosis 48.9%) at femoral neck. PHPT subjects had significant difference in both T score and BMD between lumbar spine and femoral neck.</p><p><strong><em>Conclusion:</em></strong><strong> </strong>Primary hyperparathyroidism (PHPT) is shown to be associated with significantly reduced BMD especially at femoral neck. Thus, an increased fracture risk should consider if it is left untreated.</p><p>Bangladesh J. Nuclear Med. 20(2): 129-135, July 2017</p>

scholarly journals Bone Demineralization in Postmenopausal Women: Role of Anamnestic Risk Factors

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Sandro La Vignera ◽  
Rosita A. Condorelli ◽  
Enzo Vicari ◽  
Chiara Nicoletti ◽  
Aldo E. Calogero
Keyword(s):  
Risk Factors ◽  
Postmenopausal Women ◽  
Nodular Goiter ◽  
Serum Levels ◽  
Fixed Dose ◽  
Mineral Density ◽  
Before And After ◽  
Group A ◽  
One Year ◽  
Group B

This study evaluated the effects of LT4 administration on the bone mineral density (BMD) in physiological postmenopausal women after two years of continuative treatment. 110 postmenopausal women with nodular goiter aged between 50 and 55 years were examined before and after 2 years of therapy with a fixed dose of LT4 (1.6 mcg/kg/die) for the treatment of nodular thyroid disease. The results showed that the patients on treatment with LT4 have a slight, but significant reduction of the BMD after 2 years of treatment, associated with increased serum levels of alkaline phosphatase and urinary excretion of hydroxyproline, confirming our data conducted on the same group after one year of therapy. Comparison between patients receiving LT4 (group A) or not (group B) showed that group A patients had significantly lower BMD. We demonstrated the statistically significant influence of the following risk factors on BMD: (1) body mass index<19 kg/m2; (2) the onset of menarche after the age of 15 years; (3) positive history for period of amenorrhoea; (4) nulliparity.

scholarly journals LASIK-induced Corneal Changes after Correction of Hyperopia with and without Application of Mitomycin-C

2019 ◽  
Author(s):  
Ehab M. Moawad ◽  
Ahmed A. Abd Elghany ◽  
Amr A. Gab-Alla ◽  
Osama M. Elbassiouny ◽  
Mohsen S. Badawy
Keyword(s):  
Mitomycin C ◽  
Clinical Trial Registry ◽  
Uncorrected Distance Visual Acuity ◽  
Group A ◽  
Randomized Control ◽  
One Year ◽  
Group B ◽  
Control Study

Abstract Background The study aimed to assess the role of intraoperative mitomycin-C (MMC) application during hyperopic LASIK correction (+1.00 D to +6.00 D) by examining topographic corneal changes and incidence of regression over a one-year follow-up period. Methods This comparative randomized control study included 136 eyes of 68 hyperopic patients divided into two groups; Group A included 68 eyes of 34 patients that had LASIK with the application of 0.02% MMC for 10 seconds on the stromal bed after excimer laser treatment, and group B included 68 eyes of 34 patients that had LASIK without MMC application. Uncorrected distance visual acuity (UDVA), refraction, keratometry and topography were recorded at 1st week and 1st, 3rd, 6th, and 12th months postoperation. Predictability and treatment efficacy were also recorded at the end of the follow-up period. Results Better predictability was noted in group A than in group B at the 6 month and 12 month follow-up visits, with a mean cycloplegic refraction SE of +0.5 ± 0.31 D in group A and +0.67 ± 0.39 D in group B at the 6 month visit, and +0.63 ± 0.37 D in group A and +0.89 ± 0.48 D in group B at the 12 month visit. The efficacy of the treatment at the end of the follow up period was better in group A than in group B. Group A showed fewer topographic corneal changes than group B. Conclusions Intraoperative MMC application during hyperopic LASIK achieves better predictability and efficacy and induces fewer topographic changes and lower regression rate of hyperopia during the first postoperative year. Trial registration: the Pan African Clinical Trial Registry PACTR201901543722087, on 29 January 2019.

scholarly journals A Slight Decrease in Renal Function Further Impairs Bone Mineral Density in Primary Hyperparathyroidism

2006 ◽  
Vol 91 (8) ◽  
pp. 3011-3016 ◽  
Author(s):  
Laura Gianotti ◽  
Francesco Tassone ◽  
Flora Cesario ◽  
Anna Pia ◽  
Paola Razzore ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Body Mass Index ◽  
Renal Function ◽  
Primary Hyperparathyroidism ◽  
Body Mass ◽  
Bone Mineral ◽  
Urinary Calcium ◽  
Mineral Density ◽  
Group A ◽  
Group B

Abstract Background: The impairment of renal function can affect the clinical presentation of primary hyperparathyroidism (PHPT), increasing cardiovascular morbidity, fracture rate, and the risk of mortality. Aim: The aim of the study was to assess the differences in bone status in a series of consecutive patients affected by PHPT without overt renal failure at diagnosis grouped according to creatinine clearance (Ccr). Methods: A total of 161 consecutive patients with PHPT were studied. They were divided into two groups based on Ccr. Group A had Ccr 70 ml/min or less (n = 49), and group B had Ccr greater than 70 ml/min (n = 112). PTH, total and ionized serum calcium; urinary calcium and phosphate; serum 25-hydroxyvitamin D3; serum and urinary bone markers; lumbar, forearm, and femoral bone mineral density (BMD) were evaluated. Results: Patients in group A were older than those in group B (P &lt; 0.0001). PTH levels did not differ in the two groups, whereas both urinary calcium and phosphorus were lower in group A than group B (P &lt; 0.01). Lower BMD was evident in group A at lumbar spine (P &lt; 0.002), forearm (P &lt; 0.0001), and femur (P &lt; 0.01). In asymptomatic PHPT, those with Ccr 70 ml/min or less had lower forearm BMD than patients with higher Ccr (P &lt; 0.00001). When adjusting for age and body mass index in PHPT, BMD at each site persisted being lower (P &lt; 0.05) in group A than group B. In all PHPT subjects, Ccr (beta = 0.29, P &lt; 0.0005), age (beta = −0.27, P &lt; 0.00001), and PTH levels (beta = −0.27, P &lt; 0.0005) were all independently associated with forearm BMD. Conclusions: In PHPT a slight decrease in renal function is associated with more severe BMD decrease, independent of age, body mass index, and PTH levels. This association is also present in asymptomatic PHPT and strengthens the National Institutes of Health recommendations for surgery in patients with mild PHPT.

scholarly journals Role of Prophylactic Dimenhydrinate Versus Ondansetron as an Adjunct to Dexamethasone on Post-Operative Nausea and Vomiting in Laparoscopic Abdominal Procedures

2020 ◽  
Vol 34 (3) ◽  
pp. 29-34
Author(s):  
Aaifa Khalid Niazi
Keyword(s):  
Single Dose ◽  
Nausea And Vomiting ◽  
Common Complication ◽  
Operation Theatre ◽  
Risk Patients ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Post Operative Nausea

Introduction: Post-operative nausea and vomiting (PONV) is a common complication in patients undergoing surgery. Anti-emetic prophylaxis is recommended for all high risk patients. Combination therapy is considered superior to single dose prophylaxis however its efficacy in varied laparoscopic abdominal surgical situations has not been investigated. Aims & Objectives: To compare the post-operative nausea and vomiting with Dimenhydrinate plus Dexamethasone versus Ondansetron plus Dexamethasone in patients following laparoscopic abdominal procedures. Place and duration of study: Operation Theatre, Shaikh Zayed Hospital Lahore, for one year (1st April 2015 – 31st March 2016). Material & Methods: 464 patients were placed in two groups of 232 each. Group A received prophylaxis with Dexamethasone 8 mg I/V + Dimenhydrinate 50mg I/V and Group B received prophylaxis with Dexamethasone 8 mg I/V + Ondansetron 4 mg I/V. Efficacy was judged with absence of nausea and vomiting in first 24 hours after surgery. Data was analyzed in SPSS version 27. Results: The frequency of nausea was 6% with Dimenhydrinate while was 9% with ondansetron. Similarly, vomiting was 18% vs. 24% respectively. The efficacy of Dimenhydrinate was 88% while and Ondansetron achieved efficacy in 65% cases, which was statistically significant (p<0.05). Conclusion: The combination Dexamethasone & Dimenhydrinate was more efficacious in preventing PONV than the combination Dexamethasone & Ondansetron

scholarly journals LASIK-induced Corneal Changes after Correction of Hyperopia with and without Application of Mitomycin-C

2019 ◽  
Author(s):  
Ehab M. Moawad ◽  
Ahmed A. Abd Elghany ◽  
Amr A. Gab-Alla ◽  
Osama M. Elbassiouny ◽  
Mohsen S. Badawy
Keyword(s):  
Mitomycin C ◽  
Clinical Trial Registry ◽  
Uncorrected Distance Visual Acuity ◽  
Group A ◽  
Randomized Control ◽  
One Year ◽  
Group B ◽  
Control Study

Abstract Background The study aimed to assess the role of intraoperative mitomycin-C (MMC) application during hyperopic LASIK correction (+1.00 D to +6.00 D) by examining topographic corneal changes and incidence of regression over a one-year follow-up period. Methods This comparative randomized control study included 136 eyes of 68 hyperopic patients divided into two groups; Group A included 68 eyes of 34 patients that had LASIK with the application of 0.02% MMC for 10 seconds on the stromal bed after excimer laser treatment, and group B included 68 eyes of 34 patients that had LASIK without MMC application. Uncorrected distance visual acuity (UDVA), refraction, keratometry and topography were recorded at 1st week and 1st, 3rd, 6th, and 12th months postoperation. Predictability and treatment efficacy were also recorded at the end of the follow-up period. Results Better predictability was noted in group A than in group B at the 6 month and 12 month follow-up visits, with a mean cycloplegic refraction SE of +0.5 ± 0.31 D in group A and +0.67 ± 0.39 D in group B at the 6 month visit, and +0.63 ± 0.37 D in group A and +0.89 ± 0.48 D in group B at the 12 month visit. The efficacy of the treatment at the end of the follow up period was better in group A than in group B. Group A showed fewer topographic corneal changes than group B. Conclusions Intraoperative MMC application during hyperopic LASIK achieves better predictability and efficacy and induces fewer topographic changes and lower regression rate of hyperopia during the first postoperative year. Trial registration: the Pan African Clinical Trial Registry PACTR201901543722087, on 29 January 2019.

scholarly journals LASIK-induced Corneal Changes after Correction of Hyperopia with and without Application of Mitomycin-C

2019 ◽  
Author(s):  
Ehab M. Moawad ◽  
Ahmed A. Abd Elghany ◽  
Amr A. Gab-Alla ◽  
Osama M. Elbassiouny ◽  
Mohsen S. Badawy
Keyword(s):  
Mitomycin C ◽  
Clinical Trial Registry ◽  
Uncorrected Distance Visual Acuity ◽  
Group A ◽  
Randomized Control ◽  
One Year ◽  
Group B ◽  
Control Study

Abstract Background The study aimed to assess the role of intraoperative mitomycin-C (MMC) application during hyperopic LASIK correction (+1.00 D to +6.00 D) by examining topographic corneal changes and incidence of regression over a one-year follow-up period. Methods This comparative randomized control study included 136 eyes of 68 hyperopic patients divided into two groups; Group A included 68 eyes of 34 patients that had LASIK with the application of 0.02% MMC for 10 seconds on the stromal bed after excimer laser treatment, and group B included 68 eyes of 34 patients that had LASIK without MMC application. Uncorrected distance visual acuity (UDVA), refraction, keratometry and topography were recorded at 1st week and 1st, 3rd, 6th, and 12th months postoperation. Predictability and treatment efficacy were also recorded at the end of the follow-up period. Results Better predictability was noted in group A than in group B at the 6 month and 12 month follow-up visits, with a mean cycloplegic refraction SE of +0.5 ± 0.31 D in group A and +0.67 ± 0.39 D in group B at the 6 month visit, and +0.63 ± 0.37 D in group A and +0.89 ± 0.48 D in group B at the 12 month visit. The efficacy of the treatment at the end of the follow up period was better in group A than in group B. Group A showed fewer topographic corneal changes than group B. Conclusions Intraoperative MMC application during hyperopic LASIK achieves better predictability and efficacy and induces fewer topographic changes and lower regression rate of hyperopia during the first postoperative year. Trial registration: the Pan African Clinical Trial Registry PACTR201901543722087, on 29 January 2019.

scholarly journals DNA Repair Expression Profiling to Identify High-Risk Cytogenetically Normal Acute Myeloid Leukemia and Define New Therapeutic Targets

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 35-35
Author(s):  
Ludovic Gabellier ◽  
Caroline Bret ◽  
Guillaume Bossis ◽  
Guillaume Cartron ◽  
Jerome Moreaux
Keyword(s):  
Dna Repair ◽  
Validation Cohort ◽  
Prognostic Information ◽  
Npm1 Mutation ◽  
Mutational Status ◽  
Group A ◽  
Repair Pathways ◽  
One Year ◽  
Group B

Cytogenetically normal acute myeloid leukemias (CN-AML) represent about 50% of total adult AML. Despite the well-known prognosis role of gene mutations such as NPM1 mutations or FLT3 internal tandem duplication (FLT3-ITD), clinical outcomes remain heterogeneous in this subset of AML. Given the role of genomic instability in leukemogenesis, expression analysis of DNA repair genes might be relevant to sharpen prognosis evaluation in CN-AML. Publicly available gene expression profile dataset from two independent cohorts of patients with CN-AML were analyzed (GSE12417). A list set of 175 genes involved in six major DNA repair pathways (base excision repair (BER), NER, mismatch repair (MMR), homologous recombination repair (HRR), non-homologous end joining (NHEJ) and FANC pathways) was defined using the REPAIRtoire database (http://repairtoire. genesilico.pl) and review of the literature. We investigated the prognostic value of these 175 genes involved in DNA repair. Among these genes, 23 were associated with a prognostic value, using the MaxStat R function. To further corroborate gene expression data on a functional level, CRISPR or RNAi screening publicly available data were used (Dependency Map data, Broad Institute, www.depmap.org). Among the 19 genes associated with a poor outcome, APEX (BER), RTEL1 (HRR) and COPS6 (NER) were identified as significant essential AML genes (p = 7.9e-05, 3.4e-04 and 2.8e-04 respectively). The prognostic information provided by these 23 genes was summed (sum of the beta coefficients of the Cox model for each prognostic gene, weighted by +1 or -1 according to the patient signal ≥ the probe set MaxStat value) in a DNA repair score to consider connection of DNA repair pathways. In the CN-AML training cohort (n=162), DNA repair score allowed to define a group of patients (n=87; 53,7%) with poor median overall survival (OS) of 233 days (95% CI: 184-260). These results were confirmed in the validation cohort (n=78) (median OS: 120 days; 95% CI: 36-303). In multivariate Cox analysis, the DNA repair score, NPM1and FLT3-ITD mutational status remained independent prognosis factors in CN-AML. Therefore, we investigated the interest of combining DNA repair score and NPM1/FLT3 mutational status to predict CN-AML outcome. Patients were classified according to prognosis value of DNA repair score (0 point for group I; 1 for group II; 2 for group III), and NPM1/FLT3 mutational status (0 point if NPM1 mutation without FLT3-ITD; 2 points if FLT3-ITD without NPM1 mutation; 1 point in other situations). The sum of the prognostic information was computed for all patients, allowing to separate patients in three new prognostic groups: group A including patients with 0 or 1 point, group B for patients with 2 points and group C for patients with 3 or 4 points. Combining these parameters allowed the identification of three risk groups with different clinical outcomes in both training and validation cohorts (Figure 1). In the training cohort, median OS was not reached (95% CI: NR-NR), 326 days (95% CI: 127-NR) and 236 days (95% CI: 190-263) respectively for patients in groups A, B and C. One-year OS was 90.3% (95% CI: 80.5-100) in group A, 49.3% (95% CI: 37.1-65.7) in group B, and 24.2% (95% CI: 16.2-36.2) in group C.These results were confirmed in the validation cohort where median OS was not reached (95% CI: 1278-NR), 516 days (95% CI: 308-NR) and 253 days (95% CI: 52-403) for patients respectively in groups A, B and C. One-year OS was 92.6% (95% CI: 83.2-100) in group A, 54.9% (95% CI: 39.8-75.7) in group B, and 26.5% (95% CI: 12.4-55.8) in group C. OS was statistically different between groups A, B and C in both training and validation cohorts. Combined with NPM1 and FLT3 mutational status, our GE-based DNA repair score might be used as a biomarker to predict outcomes for patients with CN-AML. DNA repair score has the potential to identify CN-AML patients whose tumor cells are dependent on specific DNA repair pathways to design new therapeutic avenues. Disclosures Cartron: Celgene: Consultancy, Honoraria; F. Hoffmann-La Roche: Consultancy, Honoraria; Sanofi: Honoraria; Gilead: Honoraria; Jansen: Honoraria; Abbvie: Honoraria. Moreaux:Diag2Tec: Consultancy.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

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