In this comparative study of catheter materials used in central venous catheterization (CVC) into large veins, the overall frequency of CVC-induced thrombosis was 12%. A 20% incidence of CVC-induced thrombosis with siliconized... more
In this comparative study of catheter materials used in central venous catheterization (CVC) into large veins, the overall frequency of CVC-induced thrombosis was 12%. A 20% incidence of CVC-induced thrombosis with siliconized polyethylene catheter, 9% with Teflon® catheter, and 6% with heparinized polyethylene catheter was seen. Thrombosis thus was significantly less common with Teflon® and heparinized polyethylene than with siliconized polyethylene (p<0.05). Repeat arm phlebography was performed in 15 patients and revealed no late formation or progression of thrombosis. Pulmonary embolism appeared in 2 patients and was fatal in one of them.RésuméL'étude comparative des cathéters employés pour le cathétérisme veineux central (C.V.C.) des grosses veines permet d'affirmer que la fréquence de la thrombose veineuse atteint au total 12%. Elle est de 20% avec les cathéters de polyethylène siliconé, de 9% avec ceux en Téflon et de 6% avec ceux en polyéthylène hépariné. Les 2 derniers types de cathéter sont donc préférable. Dans 15% cas la phlébographie répétée au niveau du bras ne décela aucune formation ou progression d'un élément thrombosant. Cependant 2 cas d'embolie pulmonaire dont 1 mortelle furent observés.AbstractoEn este estudio comparativo de los materiales de catéter utilizados para cateterización venosa central (CVC) de grandes venas, la frecuencia global de trombosis inducida por CVC fue de 12 por ciento. Se observó una incidencia de 20 por ciento de trombosis inducida por catéteres de polietileno siliconizados, 9 por ciento de catéteres de Teflón y 6 por ciento por catéter de polietileno heparinizado. Por consiguiente, la trombosis fue significativamente menor con Teflón y con polietileno heparinizado que con polietileno siliconizado (p<0.05). Se realizaron flebografías repetidas del brazo que no revelaron formación tardía o prograsiva de trombosis. La embolia pulmonar se presentó en 2 pacientes y fue fatal en uno de ellos.
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Research Interests: Statistics, Medicine, Research Support, Humans, Internal Medicine, and 15 moreFemale, Male, Cohort, Aged, Middle Aged, Adult, Aortic Aneurysm, Reference Values, Predictive value of tests, Biochemistry and cell biology, Cohort Studies, mass Screening, Medical and Health Sciences, Medical biochemistry and metabolomics, and Percentile
Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of... more
Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our short-term results. Methods: Between 1997 and July 2002, 21 patients with rAAA underwent endovascular repair according to our protocol and were followed prospectively. A retrospective analysis was also conducted of 23 rAAA patients treated with open repair from January 2001 through June 2002. Procedural and clinical data from this sample were compared to 14 contemporaneous emergent EVAR cases and analyzed to determine why the open repair patients were not treated with an endovascular approach. Results: Among the 21 patients treated with emergent EVAR since the beginning of this protocol, 6 (29%) procedures were performed under local anesthesia and 6 were performed percutaneously. Thirty-day mortality was 19%. In the comparison of 14 emergent EVAR cases to 23 open rAAA repairs, the mean duration of symptoms prior to intervention was 12 hours for the EVAR patients and &lt;1 hour for OR patients. No significant difference was found in operating time, but the EVAR group had significantly less blood loss (p=0.0001) and transfusion needs (p=0.02); duration of intensive care unit stay was significantly shorter in the EVAR group (p=0.02). Thirty-day mortality was 29% (4/14) for EVAR and 35% for OR (8/23) (p&gt;0.05). Reasons for not performing EVAR were unavailability of adequate equipment (n=11) or trained staff (n=7), hemodynamically unstable patient (n=2), mycotic aneurysm (n=2), and unfavorable anatomy in a 60-year old patient with a &lt;5-mm-long, sharply angled infrarenal neck. Conclusions: Endovascular repair of ruptured aortic aneurysms is feasible, and short-term results are promising. Good logistics, adequate training of physicians and staff in an elective setting, and versatile endografts are prerequisites for this type of treatment program.
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Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open... more
Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open surgical revascularisation has been the traditional treatment, a review of published reports suggests it to be associated with operative mortality rates of 6-9 per cent, and major morbidity rates of 22-26 per cent. Reports by others, and our own experience, suggest that endovascular treatment of mesenteric atherosclerotic obstructions with PTA (percutaneous transluminal angioplasty) and stenting may yield patency rates differing little from those associated with surgery, but significantly lower mortality (1.6%) and morbidity (5.6%).
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We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graft was inserted under local anesthesia. Aortic clamping is rapidly provided by percutaneous placement of an aortic occlusion balloon catheter.... more
We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graft was inserted under local anesthesia. Aortic clamping is rapidly provided by percutaneous placement of an aortic occlusion balloon catheter. Carbon dioxide can usually replace conventional contrast in patients with renal insufficiency. This minimally invasive procedure may reduce perioperative morbidity and mortality in patients with ruptured aortic aneurysms. The advantages and limitations of this novel technique are discussed.
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The aim of this study was to investigate whether pretreatment with drugs that interfere with platelet functions in different ways could modify the pulmonary vascular response in a porcine septic shock model. Septic shock was induced by... more
The aim of this study was to investigate whether pretreatment with drugs that interfere with platelet functions in different ways could modify the pulmonary vascular response in a porcine septic shock model. Septic shock was induced by i.v. infusion of live Escherichia coli bacteria. Bacteriemic animals were divided into five groups: untreated or pretreated with a thromboxane-A2 synthetase inhibitor (UK 38 485), a serotonin-receptor antagonist (ketanserin), a combination of these two drugs, or a platelet antiaggregating drug (dipyridamole). E. coli induced significant pulmonary hemodynamic and respiratory changes. The pulmonary responses to E. coli infusion were attenuated after pretreatment with UK 38 485 but unaffected by prior administration of ketanserin or dipyridamole. The combined pretreatment did not attenuate the pulmonary hypertension or other pulmonary responses to E. coli more than UK 38 485 alone. Dipyridamole did not alter the pulmonary circulation after bacterial infusion. It was concluded that thromboxane-A2 is an important, but not the only, mediator of the pulmonary vascular response in septic-shocked pigs and that factors such as serotonin and platelet aggregability seem to be of minor, if any, importance for the hemodynamic response.
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Research Interests: Medicine, Fibrinogen, Humans, Albumin, Female, and 8 morePubmed, Male, Hip Fractures, Clinical Sciences, Aged, Thrombosis, VaSa, and Postoperative Complications
The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous thrombosis (DVT) was tested prospectively in a randomized series of 65 patients with fracture of the hip. Diagnostic evaluation was made with... more
The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous thrombosis (DVT) was tested prospectively in a randomized series of 65 patients with fracture of the hip. Diagnostic evaluation was made with bilateral ascending phlebography on postoperative day 7. In the dextran 70 group, 5 of the 27 phlebographically studied patients had DVT, an incidence not significantly different from the 10 DVT among 28 patients given dextran 70 + dihydroergotamine. Bleeding complications showed no intergroup difference. The study did not confirm a beneficial effect of dextran 70 in combination with dihydroergotamine as compared with dextran alone in regard to thrombotic complications after surgery for hip fracture.
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Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expanded polytetrafluorethylene (ePTFE) grafts was evaluated using different precoatings of the surface or different pretreated cells. The... more
Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expanded polytetrafluorethylene (ePTFE) grafts was evaluated using different precoatings of the surface or different pretreated cells. The precoatings evaluated consisted of blood for 5 (Group I) or 15 min (Group II), fibronectin (Group IV), and cryoprecipitate (Group VI). In addition to endothelial cells subcultured immediately before labeling, cells subcultured 48 hours prior to labeling and kept in suspension were studied. Such cells were evaluated on grafts precoated with blood for 5 min (Group III) and fibronectin precoated surfaces (Group V). The amount of fibronectin that adhered to the graft surface with our technique was less den 1%. Seeding efficiency was higher with the blood precoated surfaces (5.3, 3.0, 2.2% in Groups I, II and III respectively) than fibronectin (1.7%, 1.7% in Groups IV, V respectively) or cryoprecipitate (1.9%, Group VI) precoated surfaces. No significant difference between cells immediately subcultured and these kept in suspension for 48 hours regarding adherence to blood (5.3 vs. 2.2%) or fibronectin precoated (1.7 vs. 1.7%) grafts was documented. The seeding efficiency of ePTFE grafts is low and further efforts to improve adherence must be made. From the present studies we recommend the use of blood precoating for about 5 min followed by cell incubation for approximately 10 min in order to achieve optimal seeding efficiency.
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In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular occlusion--arterial in 50 cases, venous in 24 and of uncertain etiology in six cases. Abdominal pain out of proportion to physical findings... more
In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular occlusion--arterial in 50 cases, venous in 24 and of uncertain etiology in six cases. Abdominal pain out of proportion to physical findings occurred in only eight cases. Vague abdominal symptoms with increasing tenderness led to surgical exploration in most cases. Median patient delay was 34 hours and doctor's delay 15 hours. Resection was primarily nonfeasible in 28 cases. Primary resection without second-look operation was performed in 32 cases, in seven of which signs of anastomotic insufficiency appeared. In the remaining 20 cases, primary resection (18) and/or embolectomy (3/2) was followed by a planned second-look operation within 24 hours, when five resections were performed. In a patient with viable anastomosis at second look, there were late signs of anastomotic insufficiency. Although the data do not permit firm recommendations, use of second-look operation in patients with doubtful viability of the intestine may reduce the extent of resection at primary exploration and also the incidence of insufficient anastomosis.
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1. Acta Chir Scand Suppl. 1985;529:17-27. Endothelial cell seeding of synthetic vascular prostheses. Stanley JC, Burkel WE, Graham LM, Lindblad B. PMID: 3008468 [PubMed - indexed for MEDLINE]. Publication Types: Review. MeSH Terms. ...
Research Interests: Scanning Electron Microscopy, Medicine, Dogs, Papio, Humans, and 15 moreVasculitis, Pubmed, Animals, Trypsin, Veins, Prostaglandins, ENDOTHELIUM, Polytetrafluoroethylene, Cell Survival, Polyethylene Terephthalates, Seeding, Microbial collagenase, Arteries, Blood platelets, and Staphylococcal infections
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Research Interests: Cardiology, Medicine, Thrombin, Humans, Internal Medicine, and 15 moreFemale, Male, Blood Coagulation, Body Mass Index, Aged, Middle Aged, Growth rate, Age Factors, Biological markers, Abdominal Aortic Aneurysm, Biochemistry and cell biology, Cohort Studies, Severity of Illness Index, Medical biochemistry and metabolomics, and Percentile
Research Interests: Medicine, Humans, Internal Medicine, Hospitalization, Female, and 15 moreMale, Blood Coagulation, Clinical Sciences, Aged, Middle Aged, Longitudinal Studies, Prognosis, Biological markers, Chi Square Distribution, Disease Progression, Logistic Models, Predictive value of tests, Biochemistry and cell biology, Case Control Studies, and Medical biochemistry and metabolomics
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In the article we discuss our experience in dealing with visceral aneurysms at Malmö General Hospital during the period, 1971-85. Of the total of 25 patients diagnosed, eight had ruptured aneurysms, six underwent elective surgery, and 11... more
In the article we discuss our experience in dealing with visceral aneurysms at Malmö General Hospital during the period, 1971-85. Of the total of 25 patients diagnosed, eight had ruptured aneurysms, six underwent elective surgery, and 11 underwent no surgical intervention. Of the aneurysms found, nine were of the splenic artery, five of the superior mesenteric artery and its branches, three of the pancreaticoduodenal artery, two of the celiac artery, and one of the gastroduodenal artery. There was no mortality either among patients undergoing surgery, or from complications among those treated conservatively without surgery.
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The role of serotonin (5-HT) in initial microvascular hemostasis is not fully understood. This study was made to evaluate the effect on hemostatic plug formation and laser-induced arteriolar microembolism of different substances which... more
The role of serotonin (5-HT) in initial microvascular hemostasis is not fully understood. This study was made to evaluate the effect on hemostatic plug formation and laser-induced arteriolar microembolism of different substances which counteract the effect of 5-HT. Hemostatic plug formation time and stability was measured in the rabbit mesenteric microcirculation and laser-induced embolism in the rabbit ear chamber. Ketanserine, a selective 5-HT2-receptor blocker shortened arteriolar hemostatic plug formation time. Dihydroergotamine, an unselective blocker (with 5-HT-and alpha-adrenergic receptor affinity) increased venular hemostatic plug formation time and also decreased the hemostatic plug stability. Laser-induced platelet embolism was unaltered after both ketanserine and dihydroergotamine administration. The magnitude of these changes seems to exclude an important effect of 5-HT in initial microvessel hemostasis or on platelet activity.
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Research Interests: Surgery, Nonparametric Statistics, Risk assessment, Medicine, Stents, and 15 moreProbability, Endovascular Therapy, Prospective studies, Complication, Humans, Female, Male, Clinical Sciences, Angiography, Aged, Middle Aged, Risk Assessment, Femoral Artery, Severity of Illness Index, and minimally invasive surgical procedures
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2323 LäKARTIDNINGEN NR 39 2010 VOLYm 107 trollen i Swedvasc, men i datorbaserade journalsystem kunde mätvärden från den senaste månaden identifieras hos 456 (89 procent) patienter. De senaste lipidvärdena var S-totalkolesterol 4, 2±1, 1... more
2323 LäKARTIDNINGEN NR 39 2010 VOLYm 107 trollen i Swedvasc, men i datorbaserade journalsystem kunde mätvärden från den senaste månaden identifieras hos 456 (89 procent) patienter. De senaste lipidvärdena var S-totalkolesterol 4, 2±1, 1 mmol/l och S-...
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A septic shock state was induced in cats by intravenous infusion of live Escherichia coli bacteria. Cats pretreated with an unspecific 5-HT blocker, dihydroergotamine (DHE), or with a specific 5-HT blocker, ketanserin, were compared with... more
A septic shock state was induced in cats by intravenous infusion of live Escherichia coli bacteria. Cats pretreated with an unspecific 5-HT blocker, dihydroergotamine (DHE), or with a specific 5-HT blocker, ketanserin, were compared with a series receiving bacteria without pretreatment. DHE pretreatment prevented the reduction in systemic arterial blood pressure found in the other series during the 2-hour period of septic shock. Pretreatment could not influence the increased vascular resistance in the pulmonary vascular bed or the early increase in pulmonary arterial blood pressure. Peripheral blood flow distribution was studied using radioactive labelled microspheres. Compared to bacteremia without pretreatment, the 5-HT blockers increased CNS blood flow and ketanserin also prevented the reduction in pancreatic blood flow. Gastric blood flow and gastric mucosal blood flow remained unchanged in all series as did the small intestinal total blood flow. Small intestinal mucosal blood flow, however, was reduced after 2 h of bacteremia. Microscopy revealed no gastric epithelial damage while the jejunal mucosa was characteristically damaged. There was no correlation between the changes in the small intestinal blood flow and the degree of mucosal damage, however, supporting the countercurrent theory for the pathogenesis of these lesions.
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To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our... more
To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our short-term results. Between 1997 and July 2002, 21 patients with rAAA underwent endovascular repair according to our protocol and were followed prospectively. A retrospective analysis was also conducted of 23 rAAA patients treated with open repair from January 2001 through June 2002. Procedural and clinical data from this sample were compared to 14 contemporaneous emergent EVAR cases and analyzed to determine why the open repair patients were not treated with an endovascular approach. Among the 21 patients treated with emergent EVAR since the beginning of this protocol, 6 (29%) procedures were performed under local anesthesia and 6 were performed percutaneously. Thirty-day mortality was 19%. In the comparison of 14 emergent EVAR cases to 23 open rAAA repairs, the mean duration of symptoms prior to intervention was 12 hours for the EVAR patients and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 hour for OR patients. No significant difference was found in operating time, but the EVAR group had significantly less blood loss (p=0.0001) and transfusion needs (p=0.02); duration of intensive care unit stay was significantly shorter in the EVAR group (p=0.02). Thirty-day mortality was 29% (4/14) for EVAR and 35% for OR (8/23) (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Reasons for not performing EVAR were unavailability of adequate equipment (n=11) or trained staff (n=7), hemodynamically unstable patient (n=2), mycotic aneurysm (n=2), and unfavorable anatomy in a 60-year old patient with a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5-mm-long, sharply angled infrarenal neck. Endovascular repair of ruptured aortic aneurysms is feasible, and short-term results are promising. Good logistics, adequate training of physicians and staff in an elective setting, and versatile endografts are prerequisites for this type of treatment program.
Research Interests: Evidence Based Medicine, Medicine, Endovascular Therapy, Prospective studies, Humans, and 15 moreFemale, Feasibility Studies, Male, Length of Stay, Meta Analysis, Publication Bias, Clinical Sciences, Angioplasty, European, Aged, Middle Aged, Hospital Mortality, Clinical Protocols, Abdominal Aortic Aneurysm, and Endovascular Aneurysm Repair
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Research Interests: Obstetrics, Risk assessment, Medicine, Birth Weight, Pregnancy, and 15 moreHumans, Heparin, Female, Anticoagulants, Clinical Sciences, Adult, Retrospective Studies, Chi Square Distribution, Parity, Gestational Age, Blood Loss, Postpartum Hemorrhage, Premature Birth, Control Group, and Case Control Studies
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In a study in dogs the central haemodynamic effects of dextran 70 and dihydroergotamine, both separated and combined, were evaluated. Dextran 70 gave an increased cardiac output, and peripheral resistance was reduced. The volume of blood... more
In a study in dogs the central haemodynamic effects of dextran 70 and dihydroergotamine, both separated and combined, were evaluated. Dextran 70 gave an increased cardiac output, and peripheral resistance was reduced. The volume of blood flow in the femoral vein increased, pressure recordings being mainly unchanged. Dihydroergotamine caused an increase in the systemic arterial, central venous and pulmonary artery pressure. Cardiac output was unchanged. Total peripheral resistance increased but pulmonary vascular resistance remained unchanged. The combination of dextran 70 and dihydroergotamine gave a rather more pronounced increase in pressure recordings, but the other parameters observed were only moderately affected.
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Abdominal trauma occurring in persons older than 60 years over a 30-year period (1950-79) in a well defined region of Sweden was reviewed. The 177 patients comprised 12.5% of the total with abdominal trauma during that period. Road... more
Abdominal trauma occurring in persons older than 60 years over a 30-year period (1950-79) in a well defined region of Sweden was reviewed. The 177 patients comprised 12.5% of the total with abdominal trauma during that period. Road traffic accidents were the main cause of trauma (48% of cases). The incidence of motor-car accidents rose sharply during the first two decades of the study. Injuries to the liver and bile ducts and multiple intra-abdominal injuries were more common in the elderly than in younger patients, but injury to the abdominal wall was less common. A tendency towards more severe injuries and multiple trauma with extra-abdominal involvement emerged during the study period. The mortality rate was 27.6% in the patients older than 60, but 9.1% in the overall patient series with abdominal trauma. One-third of all the deaths among the older patients were directly due to the abdominal trauma. One consequence of the increasing numbers of old people in the general population...