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Biomedical subjects

A Kroese

Publications and source records attributed to A Kroese.

At least 19 recordsLinked to original sources
PubMed2006

Blood pressure in patients with intermittent claudication increases continuously during walking.

OBJECTIVES: The purpose of this study was to compare the circulatory responses to walking in patients with peripheral atherosclerotic disease (PAD) and healthy controls. METHODS: The participants were eleven patients with diagnosed PAD, and a control group of six healthy age-matched adults. Blood pressure, heart rate (HR), and acral skin perfusion were recorded continuously before, during and after a walking exercise on a treadmill. RESULTS: The patients walked to maximum claudication distance (MCD) on a treadmill, median walking distance 103 (34-223) metres [median (range)], at 3.3 (1.0-4.5) km/h. There was a steep increase in HR and mean arterial pressure (MAP) while the patients were walking. At claudication the median rise in MAP was 46.6 (10.3-61.3) mmHg, systolic blood pressure (SP) increased by 84.9 (31.4-124.9) mmHg, and diastolic blood pressure (DP) by 21.7 (-2.1-31.7) mmHg. HR increased by 34.9 (12.9-48.1) beats/min. The control group walked for 5 minutes at 3.2 (3.0-3.3) km/h. In the control group the blood pressure initially increased moderately but stabilised thereafter. Median rise in MAP during walking was 8.5 (5.6-14.6) mmHg, SP increased by 30.9 (6.6-41.5) mmHg, and DP was reduced by -1.4 (-5.4-1.5) mmHg. HR increased by 27.1 (18.8-34.9) beats/min. We found no significant differences in acral skin perfusion during walking exercise between the patients and control group. CONCLUSIONS: In patients with PAD, blood pressure increased continuously and significantly when walking to MCD (dynamic exercise). The level of increase in blood pressure was similar to that caused in response to isometric exercise.

Aged↗
PubMed2006

Markers of vascular inflammation are associated with the extent of atherosclerosis assessed as angiographic score and treadmill walking distances in patients with peripheral arterial occlusive disease.

The importance of inflammation in atherosclerosis is well established in cardiovascular disease. However, limited data exist on the relationship between vascular inflammation and the severity of peripheral arterial occlusive disease (PAD). We investigated the relationship between biochemical markers of vascular inflammation and the diagnostic measures of PAD: ankle-brachial pressure index (ABI), maximum treadmill walking distance and angiographic score. In 127 patients (mean age 66 years; 64% males) with angiographically verified PAD, fasting blood samples were drawn for determination of selected soluble cell adhesion molecules, cytokines and chemokines. Tumor necrosis factor-alpha (TNFalpha), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and CD40 ligand (CD40L) were all significantly correlated with the angiographic score (p < 0.05 for all). After adjustment for relevant co-variates, MCP-1 and CD40L remained statistically significant (p < 0.01 for both). IL-6 was, independent of other risk factors, inversely correlated with the maximum treadmill walking distance (p < 0.01). Our cross-sectional study in PAD patients showed that the vascular inflammatory markers MCP-1, CD40L and IL-6 were significantly associated with the extent of atherosclerosis, assessed by angiographic score and maximum treadmill walking distance. These findings indicate that vascular inflammation is implicated in PAD, which might be of importance in future diagnosis and treatment of the disease.

Aged↗
PubMed1996

[Local thrombolytic treatment of peripheral arterial thrombosis and embolism].

Local intra-arterial low-dose thrombolysis has become a therapeutic alternative for acute and subacute occlusion of vascular grafts and native vessels in the lower limbs. The series comprises 31 patients treated with Streptokinase as thrombolytic agent. Complete primary thrombolysis was achieved in 20 patients, whereas in 11 patients the outcome was only partially successful or a failure. Vascular stenoses were considered to precipitate thrombosis in 18 cases, and prompted percutaneous transluminal angioplasty after thrombolysis. Two-year patency was 48% (30-66%) in the total series and 74% (56-92%) among the patients with successful primary thrombolysis. There were no major complications. Five patients sustained local inguinal haemorrhage, of whom three required surgical revision. Local intra-arterial thrombolysis is an elaborate procedure associated with potential hazardous complications. It should be carried out in institutions with radiological and vascular surgical expertise.

Adult↗
PubMed1996

[The value of preoperative thoracic CT. 19 patients with bronchial cancer surgically treated].

The incidence of bronchial carcinoma is increasing. The only curative treatment so far has been surgery. The correlation between preoperative CT thorax and peroperative/pathologic findings was evaluated in order to assess the value of preoperative CT thorax in patients with bronchial carcinoma. The thoracic CTs of 96 patients with bronchial carcinoma who were referred to our outpatient clinic from January 1992 to September 1994 were reviewed. Only 19 patients (20%) underwent surgery (seven pulmectomies, nine lobectomies, two wedge resections, one explorative thoracotomy). The remaining 77 patients received either irradiation, chemotherapy or other palliative treatment. The tumours were classified according to the TNM system (T = tumour, N = node, M = metastases) of UICC (Union Internationale Centre le Cancer). In 11 of the 19 patients who underwent surgery a correct TN classification was assessed at CT, while in four the T classification and in another four the N classification was changed after peroperative and pathologic assessment. CT showed a slight tendency to overestimate T classification. As for the N classification, overestimation and underestimation were equal. We conclude that CT thorax is valuable in the preoperative staging of bronchial carcinoma.

Adult↗
PubMed1996

Do routinely registered preoperative data provide prognostic information on the short-term outcome of distal bypass surgery?

One hundred and thirty and patients were operated on with unilateral distal bypass procedures for critical ischemia. Fifty-one patients (39%) ended up with graft occlusion or required major amputation within six months after reconstruction. Two-year graft patency was 38%. These rather disappointing results may be partly ascribed to inadequate preoperative selection of patients. Logistic regression model was used to assess whether the independent variables age, gender, diabetes mellitus, smoking, ankle-brachial pressure index (ABI), type of graft, coronary heart disease (CHD), previous vascular operation and site of distal anastomosis were associated with the outcome amputation and graft occlusion six months after reconstruction. CHD, type of graft, ABI and the location of distal anastomosis were significantly associated with outcome. The odds for amputation or occlusion was 2.4 times higher in the CHD group, 4 times higher if the anastomosis was located to the peroneal artery and 2.6 times higher for synthetic grafts. The logistic regression model was statistical significant (p = 0.03). However, the model did not aid sufficiently in the prediction of outcome, since one third was erroneously classified as success or failure. Cox's proportional hazard regression was employed to estimate the influence of the independent variables on graft patency. Favorable patency was found for those with distal anastomosis located to the tibial arteries, the non-CHD group and for higher ABI values. There was a trend towards significance for better patency in the autogenous vein group (p = 0.06). Although combinations of risk factors usable for preoperative prediction of the likelihood of graft failure, appropriate selection models of patients suitable for distal bypass operation have to be improved, to minimize the number of failed procedures.

Aged↗
PubMed1994

[Electromagnetic therapy for patients with intermittent claudication--is it effective?].

A treatment based on electromagnetic principles (Elmedistraal) has been tested on 12 patients with intermittent claudication. What initiated this investigation was the publicity in the media around this treatment and its supposedly positive effect on peripheral circulation. 12 patients received ten placebo and ten active treatments. The patients were thus their own control. We looked for changes in clinical signs, ankle/arm pressure index (ultrasound Doppler) and maximal walking distance (treadmill). The patients reported changes in symptoms by means of a visual analog scale. In this study neither subjective nor objective effects of treatment with Elmedistraal could be documented in patients with claudication.

Aged↗
PubMed1992

[Ultrasonography for early diagnosis of abdominal aortic aneurysm].

2,654 males aged 60 years or older were invited to attend a screening examination using ultrasound to detect abdominal aortic aneurysm. 1,256 met up. A fee of NOK 150 was charged. 92 aneurysms were detected (7.3%) 69 were smaller than 40 mm and 23 were 40 mm or larger. During the observation period (18 months from start of the study and nine months after screening stopped) 17 of the patients with an abdominal aortic aneurysm of 40 mm or larger had elective operations. All patients survived without major complications. Owing to the high prevalence of abdominal aortic aneurysm, the low cost of screening, and the safety of elective surgery, it is suggested that screening for detection of abdominal aortic aneurysm should be carried out on a larger scale.

Aged↗
PubMed1992

Ultrasonographic screening for abdominal aortic aneurysm.

OBJECTIVE: To assess the prevalence of abdominal aortic aneurysm in a selected group of men over the age of 60, and define main risk factors. DESIGN: Population based screening study. SETTING: Private Norwegian health maintenance organisation. SUBJECTS: 500 men over the age of 60 years. INTERVENTIONS: General examination by a general practitioner, together with measurements of blood glucose and serum cholesterol concentrations. Abdominal scan with a B-mode ultrasound imager. MAIN OUTCOME MEASURES: An increase in the diameter of the aorta of more than 150% over the diameter at the origin of the superior mesenteric artery, or maximum diameter of more than 29 mm. Correlation with history of smoking, serum cholesterol concentration, and general health. RESULTS: 29 patients (5.8%) had small, and 12 (2.4%) had large, abdominal aortic aneurysms. There was a significant association between aortic aneurysm and history of smoking (p < 0.01), poor health (defined as coexistent hypertension, cardiovascular disease, or diabetes mellitus) (p < 0.01), and increasing age (p = 0.025). There was no association with hypercholesterolaemia. CONCLUSION: Ultrasonic screening of groups at risk followed by elective operation may reduce mortality of abdominal aortic aneurysm.

Age Factors↗
PubMed1988

Laser Doppler flowmetry in evaluation of lower limb resting skin circulation. A study in healthy controls and atherosclerotic patients.

Laser Doppler flowmetry (LDF) was used to evaluate lower limb resting skin perfusion in sixty subjects divided into four groups: healthy young and elderly controls, and patients with intermittent claudication or critical ischaemia. Measurements were performed in pulp skin containing microvascular AV anastomoses and in the skin of leg and thigh where these shunts are absent. In toe pulp controls and claudicators had higher perfusion values than in leg and thigh skin (p less than 0.01), indicating that the LDF method evaluates flow both in nutritional capillaries, AV anastomoses and in dermal vascular plexa. Elderly controls had higher flux values in the pulp than claudicators (p less than 0.01), and claudicators had higher values than patients with critical ischaemia (p less than 0.01), showing that LDF could differentiate between the clinical groups. Study of reproducibility confirmed that values were reproducible on a given population. Day to day variation was considerable in individual subjects, probably because of changes in sympathetic vascular tone and because of different vascular architecture in the measuring volumes which are only some few mm3. The fact that LDF measures total skin blood flow explains why several papers have found a poor correlation between LDF and methods which mainly evaluate nutritional blood flow. The method is non-invasive, continuous and easy to perform. Laser Doppler flowmetry may have several clinical applications, like evaluating progress of atherosclerotic disease or therapeutic effects of drugs or operations. To increase the reproducibility of resting skin flux measurements local heating of the skin is recommended and the measurements should be performed with an integrating probe, which averages the readings obtained at several positions simultaneously.

Adult↗
PubMed1987

Ketanserin in intermittent claudication: effect on walking distance, blood pressure, and cardiovascular complications.

In a 7-center Scandinavian double-blind placebo-controlled study of 179 patients with intermittent claudication, the effect of the serotonin antagonist ketanserin was evaluated on walking distance, brachial and ankle blood pressure, and symptoms. For all centers together, pain-free walking distance was significantly increased after 6 months with both ketanserin (+65%; 71 patients) and placebo (+42%; 78 patients), with no significant difference. However, there was large variability among centers. Classification of "responders" (doubling of walking distance) and patients who deteriorated (decrease of walking distance or dropout for inefficacy) showed significantly more patients responding and significantly fewer patients deteriorating with ketanserin than with placebo. Systemic blood pressure was significantly decreased by ketanserin in hypertensive, but not normotensive, patients, while ankle pressure was unaffected. The incidence and nature of side effects were equal with ketanserin and placebo, but there were more side effects causing dropout in the ketanserin group. An unexpected and possibly important observation was the occurrence of six serious cardiovascular events (myocardial infarction, cerebrovascular complications, and development of rest pain) in the placebo group but none in ketanserin-treated patients. Moreover, there were four additional similar complications in the placebo run-in period. Ketanserin appears to be beneficial in a subgroup of patients with intermittent claudication. A fortuitous finding of this study is that ketanserin might possess a protective effect against thrombovascular complications in patients with intermittent claudication.

Adult↗
PubMed1986

Early complications with a new bovine arterial graft (Solcograft-P).

In three separate centers of vascular surgery in Norway, a total of 26 patients underwent implantation of a new bovine arterial graft (Solcograft-P) for femoropopliteal or femorotibial bypass or arterial patch-plasty. Serious complications--graft deterioration and formation of aneurysm or pseudoaneurysm--arose in eight patients, all within 4 months after the implantation. In central Europe only four anastomotic pseudoaneurysms have been reported after about 700 Solcograft implantations, even with longer observation time. Possible causes of the difference in complication rates are discussed.

Aged↗
PubMed1982

Physical activity and the peripheral circulation.

Endurance training leads to adaptations in the peripheral circulation and enzymatic changes in musculature to meet increased metabolic demand during physical work. These changes occur in normal subjects and in patients with peripheral atherosclerosis. It is uncertain whether training can prevent atherosclerosis. Training of leg muscles often has a good clinical effect on patients with atherosclerotic arterial insufficiency.

Arteriosclerosis↗
PubMed1977

Alteration of plasma hypoxanthine concentration during ischaemia in the forelimb of the pig.

Ischaemia in the forelimb of pigs was induced by clamping the main artery of an 'isolated leg' preparation. In plasma from the brachial vein the hypoxanthine concentration increased linearly between 10 and 25 min of ischaemia. The average increase in plasma hypoxanthine concentration in ten experiments was 25-0 micromol/1 after 30 min of ischaemia. It is concluded that the plasma hypoxanthine level might be a useful indicator of tissue hypoxia caused by impairment of peripheral blood flow.

Animals↗
PubMed1977

Axillo-axillary bypass for subclavian artery occlusion. Report of a case with impending gangrene of the hand.

A 72-year-old woman with occlusion of the right subclavian artery and impending gangrene of the hand was succssfully treated with a subcutaneous axillo-axillary vein bypass. This method was chosen because of atrophic skin changes due to radiation therapy for breast cancer. The operation may, however, be used in the treatment of atherosclerotic obstructions of the subclavian artery in general and may be particularly advantageous in old and poor risk patients.

Arterial Occlusive Diseases↗
PubMed1976

Blood circulating changes in the eye and limbs with relation to pregnancy and female sex hormones.

Alterations in corneal indentation pulse (CIP) amplitudes and pulse volume recordings (PVR) on the limbs were demonstrated in pregnant women, indicating that significant changes occur in the peripheral blood circulation during pregnancy. The PVR measured at week 30-36 of gestation demonstrated a significant increase when recorded on the forearm and index finger. In the eye an increase in CIP amplitudes was found early in pregnancy. From week 20 on, however, a steady decrease occurred, until the CIP amplitudes at term averaged about 1/3 of the values from normal, non-pregnant women. Similar changes, although less pronounced, were demonstrated in the ocular blood circulation during oral contraceptive treatment and, to some extent, during menstruation. Intake of gestagens and diaethyl-stilboestrol did not alter the CIP amplitudes.

Adolescent↗
PubMed1976

The Christiansen hip prosthesis preliminary results.

The combined endo- and total hip prosthesis of Christiansen is described. In this prosthesis an articular connection, or trunnion bearing, is introduced between the head and stem components in order to reduce friction at the acetabular joint. The stem portions of both prostheses are identical. The endoprosthesis was inserted in 50 patients, who were followed-up during one year. The results were according to the classification of Love (Surg. Clin. N. Amer., 1963, 43, p. 1217): excellent in 60%, good in 22%, and poor in 18% of cases. In addition some results from other Norwegian hospitals were presented.

Femoral Neck Fractures↗