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Biomedical subjects

A Klaerke

Publications and source records attributed to A Klaerke.

At least 19 recordsLinked to original sources
PubMed2000

[Acute glaucoma following endarterectomy of internal carotid artery].

A 71 year-old woman had 85% and 60% stenoses of the right and left internal carotid arteries, respectively. Right-sided endarterectomy was performed because of amaurosis fugax. Two days postoperatively, she developed classical symptoms and signs of acute glaucoma. Right-sided acute angle closure glaucoma was diagnosed by tonometry and gonioscopy, and treated with laser-iridectomy. The patient was discharged two days later without neurological or ophthalmological deficits. Manifest acute glaucoma postoperatively seems never to have been reported. However, the choroid is not autoregulated, and the intraocular pressure has been reported to increase after internal carotid-endarterectomy.

Acute Disease↗
PubMed1997

[Local intra-arterial thrombolysis. Results in arterial thromboses and graft occlusions].

The purpose of this study was to evaluate the efficacy of intraarterial low-dose recombinant tissue plasminogen activator (rt-PA) in patients with acute or subacute thrombosis of the native arterial system or in an arterial artificial or venous by-pass graft. Twenty patients with 22 cases of thrombosis received intraarterial thrombolysis during the period 1.1.1995 to 31.12.1995. Ten patients (50%) achieved complete radiological thrombolysis, and in seven patients (35%) partial thrombolysis was achieved. Half of these patients required a subsequent PTA or an operation. There were only three patients (15%) where no lysis occurred. The results seemed very satisfactory and we conclude that thrombolysis should be considered as the first-choice treatment in this category of patients. The indications may be extended to patients with critical ischaemia with the introduction of the pulse-spray technique as the time to complete lysis is considerably shorter with this technique.

Evaluation Studies as Topic↗
PubMed1992

EDTA treatment of intermittent claudication--a double-blind, placebo-controlled study.

A double-blind, randomized multicentre study was undertaken to evaluate the possible effect of chelation treatment with ethylenediamine-tetraacetic acid (EDTA) in patients with severe intermittent claudication. A total of 153 patients received 20 intravenous infusions of either 3 g Na2EDTA or placebo during a period of 5-9 weeks. Vitamin, mineral and trace element supplements were administered orally. The changes observed in the pain-free and maximal walking distances, measured on a treadmill, were similar in the two groups. During the 3-month (n = 149) and 6-month (n = 123) follow-up period, no long-term therapeutic effect of EDTA could be demonstrated. The ankle-brachial blood pressure index remained unchanged throughout the study period. This study failed to demonstrate any effect of EDTA chelation treatment in intermittent claudication.

Aged↗
PubMed1989

[The effect of systemic N-acetylcysteine on postoperative expectoration. A prospective, randomized double-blind study].

A material of 110 consecutive patients submitted to elective upper abdominal laparotomy participated in a randomized double-blind investigation of the effect of N-acetylcysteine (Mucomyst) administered systemically in the recommended dosage on postoperative expectoration. As an effect variable the quantity of expectorate and the viscosity as assessed subjectively by the physiotherapists in the department on a visual analog scale was employed. N-acetyl-cysteine was not found to have any effect on the postoperative expectoration as assessed by the quantity and the viscosity.

Clinical Trials as Topic↗
PubMed1989

Systemic administration of N-acetylcysteine has no effect on postoperative lung function following elective upper laparotomy in lung healthy patients.

In a randomized, double-blind study, 131 consecutive patients, subjected to elective upper laparotomy, were prophylactically given the recommended dose of N-acetylcysteine (NAC) (Mucomyst, ASTRA) (200 mg x 3) or placebo against postoperative pulmonary complications. The effect was evaluated by lung function tests (VC and FEV1), arterial blood gas analyses and chest x-ray. No benefit could be demonstrated, either to postoperative pulmonary function or in the frequency of atelectasis in the recommended dose. However, no patients with preoperative bronchopulmonary disease demanding treatment with bronchodilatators were included in the study. A positive effect of NAC in this category of patients could not be excluded.

Acetylcysteine↗
PubMed1989

Peroral N-acetylcysteine as prophylaxis against bronchopulmonary complications of pulmonary surgery.

In a randomized, double-blind study, 38 patients undergoing elective pulmonary surgery were given N-acetylcysteine (Fabrol, Ciba-Geigy) in recommended dosage (200 mg X 3) or placebo. The prophylactic effect on postoperative bronchopulmonary complications was evaluated from arterial blood-gas analyses and chest radiography. The alveolo-arterial oxygen difference increased substantially and similarly in both patient groups, and no intergroup difference was found in incidence of atelectasis or pneumonic infiltration. Thus there was no demonstrable benefit of N-acetylcysteine in the recommended dosage. For future similar studies, employment of considerably higher doses is proposed.

Acetylcysteine↗
PubMed1988

Perforated gastric ulcer.

A retrospective study is presented of 297 patients operated upon for perforated benign gastric ulcer in Denmark from 1975 to 1984. Male:female ratio was 0.9:1, mean age 64.2 years. The numbers of gastric and prepyloric perforations were almost equal (156:141), but gastric perforations were more frequent in elderly women and prepyloric perforations in younger men. Simple closure was performed in 83 per cent of the patients, gastric resection in 14 per cent and simple closure and vagotomy in 3 per cent. The postoperative mortality rate was 21 per cent and was related to the high proportion of elderly patients with concurrent diseases and delayed treatment.

Adolescent↗
PubMed1988

Gastrocolic fistulas.

Sixteen patients were treated for gastrocolic fistula arising as a complication of peptic ulcer (11 cases), colonic perforation (2), gastric cancer (1), colonic cancer (1) or pancreatitis (1). The predominant symptoms were diarrhoea, weight loss and abdominal pain. Barium meal and barium enema were the most reliable means of diagnosis, and no fistula was gastroscopically demonstrable. A one-stage en bloc resection of the involved gastrocolic region was performed in eight cases. Other operations were simple excision (3), gastric resection with closure of the colonic wall (2) and colectomy with closure of the gastric wall (2). In one case cure was achieved with cimetidine, without surgical intervention. Four patients died postoperatively and two had recurrence of fistula.

Adult↗
PubMed1987

Treatment of cervical disc disease using Cloward's technique. Part V. The effect of reoperations.

Among 1,106 patients with cervical disc disease in whom Cloward's operation had been performed over a fifteen-year period, 145 patients were reoperated upon with a new Cloward procedure. In the 1st year after the first operation 3/4 of the patients were operated upon on the previous level, whereas reoperations performed later mainly were done on new levels. The effect of the reoperation was poorer than the effect of the 1st operation. Early reoperations--which were due to: an initially unsatisfactory clinical course, postoperative complications or graft problems--had a poor result, but late reoperations--which were caused by relapses--showed a result corresponding to the first operation. The frequency of relapses leading to a 2nd Cloward operation was 8.8% in the first year falling to 0.2% in the following years of observation.

Cervical Vertebrae↗
PubMed1987

The significance of preoperative radiological examinations in patients treated with Cloward's operation.

During a fifteen-year period 1,106 patients with symptoms and signs of cervical disc disease underwent Cloward's operation. Plain x-rays were performed in 94%, but the severity and extension of degenerative changes had no prognostic value. In 91% of the patients myelography was performed and in recent years mainly metrizamide was used as it was found to be more accurate. The findings on the myelograms were correlated according to age, severity and number of affected disc levels, but were independent of the duration of symptoms. Patients with medullary symptoms were found more often than not to have an anterior indentation into the spinal canal whereas most patients with radicular symptoms had wide cervical root sleeves or lateral compression. The best outcome was found among patients with monosegmental symptoms and signs and one affected disc level on the myelogram underlining that the indication for surgery in cervical disc disease should be based on both clinical and radiological findings.

Adult↗
PubMed1987

Evaluation of the usefulness of enzymatic diagnosis of myocardial infarction in patients with acute arterial occlusion of the lower extremities.

The serum activities of aspartate aminotransferase, lactate dehydrogenase, creatine kinase and estimated creatine kinase isoenzyme MB (CK-B) were investigated in 12 patients before and after revascularization of ischaemic lower extremities. All patients suffered from sudden lower limb arterial occlusion and underwent embolectomy through a small arteriotomy in the groin. The median serum activity of all four enzymes was elevated before surgery and further increased during the first 24-48 h after revascularization. Median serum activity of aspartate aminotransferase, creatine kinase and lactate dehydrogenase were continuously elevated 7 days after the operation. A high relative CK-B activity coincided in one patient with the development of electrocardiographic evidence of acute myocardial infarction. It is concluded that any of these four enzymes should be used with caution in the diagnosis of acute myocardial infarction before, during or after operation in patients who have sustained prolonged ischaemia of the lower extremities.

Acute Disease↗
PubMed1987

Immunity against tetanus and response to revaccination in surgical patients more than 50 years of age.

Several instances of fatal postoperative tetanus have been reported, and it has recently been stated that failure to secure adequate immunization for surgical patients may have medicolegal repercussions. In order to investigate according to which criteria for the immunization surgical patients can be considered protected, 178 patients who were more than 50 years of age and who were admitted electively during one year to two surgical departments were studied. To investigate immunity relative vaccination history, all patients admitted during the first two months were offered participation in this study. One hundred and twenty-seven (86 per cent) of these patients were studied by detailed registration of vaccination history and determination of antitoxin concentration in serum. Forty-seven per cent had never been vaccinated against tetanus and 67 per cent had antitoxin concentrations in serum below the protective level. To investigate in detail the duration of immunity and the effect of revaccination, patients with documented complete primary vaccination only were studied during the entire period. An additional 51 patients have been entered into the study during the last ten months. Antibody concentration in the serum corresponded to a continuous fall off in immunity after vaccination. Patients who had received a complete three dose primary vaccination within the last five years or a revaccination within the last ten years were well protected. Forty-four patients received revaccination during the study and were controlled by blood sample four weeks later. Every patient obtained satisfactory antibody concentrations, and it was concluded that no special requirements in recommendations for vaccination are needed, even for elderly patients. Thirteen patients who underwent extensive surgical procedures had serial blood samples taken every three days. Antitoxin concentrations in serum increased sigmoidally with time, and the slow initial increase suggested that revaccination should optimally be given some days before the operation to assure protection in the first few postoperative days.

Age Factors↗
PubMed1986

Revaccination of adults against diphtheria. II: Combined diphtheria and tetanus revaccination with different doses of diphtheria toxoid 20 years after primary vaccination.

Immunity following diphtheria vaccination in childhood is temporary, and recent outbreaks of diphtheria in adult populations evoked interest in the effect of and side-reactions to revaccination of adults. 237 military recruits were randomly allocated to revaccination with 6 Lf tetanus toxoid or 6 Lf tetanus toxoid combined with 2 Lf or 5 Lf diphtheria toxoid. Side-reactions were recorded one week later, and antitoxin response was assessed after 4 weeks. Protective serum diphtheria antitoxin levels were attained by all subjects receiving diphtheria toxoid containing vaccines. Antibody response was related to dose, indicating a safer long-term protection by revaccination with 5 Lf diphtheria toxoid. All vaccinees, except one without documentation for primary vaccination, attained high tetanus antitoxin levels. Interference phenomena between toxoids were insignificant. Mild local reactions were reported by 22% of the vaccinees. More pronounced local reactions were experienced by 5% and systemic reactions by 3%, independent of vaccine. No serious reactions were observed. Reactions were significantly related to tetanus antitoxin response only. It was concluded that combined revaccination of adults, primary vaccinated around 20 years previously, may be performed without immune assessments.

Adult↗