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Biomedical subjects

B Eklöf

Publications and source records attributed to B Eklöf.

At least 55 records · Page 3Linked to original sources
PubMed1981

Temporary incomplete ischemia of the legs induced by aortic clamping in man: effects on central hemodynamics and skeletal muscle metabolism by adrenergic block.

The hemodynamic changes which occur when clamping and unclamping the aorta during reconstructive surgery might be a threat to the elderly patient with concomitant cardiac disease. In addition, the cross-clamping induces a temporary ischemia of the legs, with severe metabolic derangement after the release of the aortic clamp. We have studied the effect of a intraoperative adrenergic block (phenoxybenzamine plus metoprolol) on the central circulation and the skeletal metabolism in 14 patients undergoing aortic reconstruction to treat occlusive arteriosclerotic disease. Cardiac output, heart rate, arterial and pulmonary artery pressures, and cardiac filling pressures, as well as femoral venous blood flow were studied. Biopsy specimens of the lateral vastus muscle and blood samples from the radial artery and iliac vein were taken before aortic clamping, and before, 30 minutes, four and 16 hours after the aorta was unclamped, as well as five days postoperatively. In addition, intramuscular temperature and pH were measured. Glycogen, glucose, lactate, pyruvate, ATP, ADP, AMP, phosphocreatine (PCr) and creatine (Cr) contents of the muscle and lactate and pyruvate concentrations in iliac venous and radial arterial blood were determined using enzymatic fluorometric techniques. Mean arterial blood pressure (MAP) averaged 80 mmHg before clamping, chiefly because of the low systemic vascular resistance (SVR), and left ventricular stroke work (LVSW) was normal. At clamping MAP, SVR, LVSW, remained unchanged. MAP and LVSW were unaffected even though SVR decreased slightly after the aorta was unclamped and resulted in an increased cardiac output, mainly due to a higher stroke volume. No major change in the pulmonary circulation was observed. During clamping the muscle lactate/pyruvate ratio increased, intramuscular pH and femoral venous blood flow decreased indicating insufficient tissue perfusion. Energy charge (EC), the adenylate (ATP + ADP + AMP) and creatine (PCr + Cr) pools were, however, unchanged. In spite of a restored blood flow to the legs, a severe metabolic derangement of the muscle was observed after declamping, with lowered EC, ATP + ADP + AMP and PCr + Cr indicating cellular damage. No improvement in the condition of the cells was observed 16 hours after operation. In conclusion, we found that by using neurolept anesthesia and an intraoperative adrenergic block in combination with a differentiated fluid therapy the central circulation stabilized and was largely unaffected by the clamping and unclamping procedures. In spite of the improved central hemodynamics no favorable effect on the skeletal muscle metabolism was observed.

Adenosine Diphosphate↗
PubMed1981

Temporary incomplete ischemia of the legs caused by aortic clamping in man: improvement of skeletal muscle metabolism by low molecular dextran.

Temporary infrarenal clamping of the aorta during reconstructive surgery induces incomplete ischemia of the leg muscle. After release of the clamp, severe muscle metabolic derangement with loss of high-energy phosphate compounds has been observed, indicating a dysfunction or damage of the muscle cells. In six patients operated on for occlusive aortoiliac disease, low-molecular-weight dextran (LMWD) was peroperatively administered for optimal volume loading and prevention of clotting. No heparin was used. Before, during and after the clamping period the central hemodynamics were monitored, and glycogen, glucose, lactate, pyruvate, phosphocreatine (PCr), creatine (Cr), ATP, ADP and AMP content in the thigh muscle were analyzed using enzymatic fluorometric techniques. Even though ischemia developed during the occlusion, no decline in the adenylate (ATP + ADP + AMP) or creatine (PCr + Cr) pools occurred after the clamp was released, and the energy charge of the adenine nucleotides remained unchanged. It is suggested that LMDX prevents rheologic changes impairing the microcirculation during and after the ischemic period, and thereby improves oxygenation of the muscle tissue upon reperfusion.

Adenosine Diphosphate↗
PubMed1981

The celiac compression syndrome: myth or reality?

Fifteen patients were operated on for compression of the celiac artery with division of the median arcuate ligament. Initially most patients were released from their preoperative abdominal pain. At follow-up after 1 1/2-9 1/2 years only two patients were asymptomatic. Our results corroborate the nonentity of the celiac compression syndrome. The existence and identification of a subgroup of patients with symptomatic compression of the celiac artery is discussed.

Abdomen↗
PubMed1980

Incidences of fatal postoperative pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: an international multicentre study.

A total of 4352 patients were admitted to a prospective' randomised multicentre trial comparing the prophylactic efficacy of dextran 70 and low-dose heparin against fatal pulmonary embolism after elective operations for general, orthopaedic, urological, and gynaecological conditions. Out of 3984 patients correctly admitted, 1993 were allocated to receive dextran 70 and 1991 to receive low-dose heparin. Withdrawal of prophylaxis because of bleeding or technical difficulties occurred more often in the heparin group, but allergic reactions were more common in the dextran group. Of the 75 patients who died within 30 days after operation, 38 had been given dextran and 37 low-dose heparin. Necropsy was performed in 33 and 32 of these cases respectively. In six patients in each group pulmonary embolism was the sole or a contributory cause of death. Of these, five patients in the dextran group and two in the heparin group had received a full course of prophylaxis. There was no statistically significant difference between the two treatment groups in the incidence of fatal pulmonary embolism after a full course of prophylaxis.

Aged↗
PubMed1980

Aneurysm of the popliteal vein as a cause of pulmonary embolism.

A case of recurrent pulmonary embolism, secondary to thrombosis in an aneurysm of the popliteal vein is described. The source of embolism was not obvious clinically, and it was discovered only after venography. The anomaly was amenable to surgical intervention and the patient was cured from his source of embolism. We have found only one similar case in the literature.

Adult↗
PubMed1980

Axillofemoral bypass reconstructions in sixty-one patients with leg ischemia.

During a 5-year period, 61 axillofemoral bypass operations have been performed in patients regarding as poor risks for conventional bifurcations procedures with arteriosclerotic occlusive disease and in patients with graft infections. Velour-Dacron grafts and expanded polytetrafluoroethylene (PTFE)-grafts have been used. The results are encouraging with a 3 year graft patency rate of 75% and a 3 year limb salvage rate of 90%. The expanded PTFE graft is a suitable graft for this purpose, and the use of axillofemoral bypass grafting is recommended as an alternative to the conventional aortoiliac/femoral bypass graft when dealing with high risk patients and patients with graft infections.

Aged↗
PubMed1980

Aorto-iliac disease in premenopausal women.

Fifteen premenopausal women had by-pass reconstruction performed for aorto-iliac disease. A high prevalence of smoking, oral contraception and hyperlipemia was found. The outcome of reconstructive surgery was initially excellent. Serious complications and progress of the arteriosclerosis, however, made the late results more doubtful.

Adult↗
PubMed1979

Sparks mandril, velour Dacron and autogenous saphenous vein grafts in femoropopliteal bypass.

Ninety-nine consecutive vascular reconstructions with femoropopliteal bypass performed during 1973--6 have been reviewed. A Sparks mandril was used in 11 patients, reversed autogenous saphenous vein in 30 and velour Dacron prostheses in 58. The indication for operation was severe ischaemia in 79 per cent. The overall patency rate at 12 months was 70 per cent for autogenous vein, 46 per cent for velour Dacron prosthesis and 18 per cent for Sparks mandril. When the distal anastomosis was located above the knee the patency rate was 100 per cent and 87 per cent for autogenous vein and velour Dacron graft respectively, while the corresponding figures for distal anastomosis below the knee were 58 per cent and 11 per cent. At follow-up 60 per cent of the patients showed improvement owing to the vascular reconstruction.

Adult↗
PubMed1979

Metabolic changes in blood and skeletal muscle in reconstructive aortic surgery.

The declamping shock has been attributed to reactive hyperemia with pooling of blood in the legs, metabolic acidosis following lactate accumulation in the ischemic leg muscles and hyperkalemia. We have studied eight patients undergoing arterial reconstruction with temporary aortic occlusion, in six cases because of obstructive arteriosclerotic disease and in two cases for aortic aneurysm. Muscle biopsies from the lateral vastus muscle as well as blood samples from the iliac vein, the superior caval vein and the radial artery were taken before clamping of the aorta, just before declamping, and 20 minutes after restitution of leg blood flow. ATP, ADP, AMP, phosphocreatine (PCr), creatine (Cr), glycogen, glucose, lactate, pyruvate and NH4+ from the immediately frozen muscle biopsies as well as lactate and pyruvate in the iliac vein and central venous blood were determined with an enzymatic, fluorometric technique. Only one patient reacted with a temporary hypotension at declamping. Arterial pH was unaffected during the operation, and no hyperkalemia was noted. During clamping of the aorta an increased lactate/pyruvate ratio in muscle indicated tissue hypoxia. Energy charge (EC) was, however, unchanged and the adenylate pool was maintained possibly due to a decrease in PCr. In spite of the restitution of blood flow after declamping of the aorta, no normalization of the metabolic state was seen, not even 20 minutes after the release of the clamp. EC was still unchanged but a significant decrease of both the adenylate and creatine pools was seen. These findings might indicate a damage of the mitochondria and the cellular membranes in skeletal muscle after temporary arterial occlusion.

Adult↗
PubMed1978

Ultrasonography and angiography in the diagnosis of abdominal aortic aneurysm.

A material of 130 consecutive patients with clinically possible abdominal aortic aneurysm was reviewed. All of them were examined by ultrasonography and 23 by abdominal aortography as well. Ultrasonography revealed aortic aneurysm in 42 patients. The management of this entity and the value of different diagnostic methods are discussed. The importance of ultrasonography as a non-invasive and accurate diagnostic aid is emphasized.

Aged↗