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Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 19 recordsLinked to original sources
PubMed2002

Renal hemodynamics during carbon dioxide pneumoperitoneum: an experimental study in pigs.

BACKGROUND: Laparoscopic living donor nephrectomy is increasingly being performed, although the effects of carbon dioxide pneumoperitoneum (CO2 PP) on renal function and hemodynamics and the levels of vasopressin are not well studied. METHODS: Renal blood flow, renal venous pressure, urine output, and vasopressin concentrations in renal venous blood were measured in pigs subjected to 12 mmHg of CO2 PP for 150 min. RESULTS: Renal blood flow was decreased at induction of PP and increased during the first 30 min after exsufflation. Renal venous pressure was increased during PP. There was indirect evidence of a decrease in urine output during PP. No changes in renal venous vasopressin concentrations were seen. CONCLUSION: A CO2 PP of 12 mmHg causes changes in renal hemodynamics and urine output. No changes in vasopressin levels were seen in this pig model, suggesting that other explanations for the observed changes must be sought.

Animals↗
PubMed2002

Revascularization of the superior mesenteric artery after acute thromboembolic occlusion.

BACKGROUND: The outcome and prognostic factors after revascularization of acute thromboembolic occlusion of the superior mesenteric artery (SMA) are poorly documented. METHODS: Sixty patients with acute thromboembolic occlusion of the SMA had revascularization procedures at 21 hospitals from 1987 to 1998. They were registered prospectively in the Swedish Vascular Registry. Patient files were analysed retrospectively. RESULTS: The median age of the patients was 76 years; 73 per cent suffered from cardiac disease and 23 per cent had previous vascular surgery. Onset of symptoms was classified as sudden (30 per cent), acute (33 per cent) or insidious (37 per cent). The occlusions were thought to be either embolic (67 per cent) or thrombotic (33 per cent). The diagnosis was suspected on first examination in 32 per cent of patients, a group whose median time to operation was shorter (P = 0.01). Fifty-eight patients had an exploratory laparotomy and subsequent revascularization, and two were treated with thrombolysis alone. Second-look laparotomy was performed in 41, and third look in eight patients; 19 required an additional bowel resection. The overall mortality rates were 43, 52, 60 and 67 per cent at 30 days, discharge, 1 and 5 years, respectively. No patient was dependent on intravenous nutrition after 1 year. Previous vascular surgery resulted in a higher institutional mortality rate (79 per cent; P = 0.02). Patients who had a sudden onset of symptoms outside hospital had a better outcome (mortality rate 27 per cent; P = 0.02). CONCLUSION: Many non-diagnostic radiological examinations were performed and a routine second-look is warranted. The results suggest that attempts at revascularization procedures for acute mesenteric ischaemia may improve the outcome.

Adult↗
PubMed2002

Duplex scan findings in patients with spontaneous cervical artery dissections.

AIM: to report duplex scan findings in patients with spontaneous internal carotid artery (ICA) or vertebral artery (VA) dissection. MATERIAL AND METHODS: the records of 24 patients (13 males and 11 females, median age 48 years [range 25-68 years]) with spontaneous extracranial ICA dissection (n=20) or VA dissection (n=4), identified between January 1995 and December 1999, were retrospectively analysed. RESULTS: four different abnormal flow patterns were observed in patients with ICA dissection: (a) absence of flow (15%), (b) staccato flow (50%), (c) reduced flow velocity (25%) and, (d) stenotic flow (10%). B-mode ultrasound showed a homogenous echolucent lesion in eight patients and a double lumen in two. Staccato flow along the entire ICA was observed in only four patients without verified dissection during the study period. In the four patients with VA dissection, duplex scanning demonstrated staccato flow in three and reversed low-amplitude pulsatile flow in one. CONCLUSION: duplex scanning is an important noninvasive diagnostic modality in patients with cervical artery dissection. Staccato flow along the extracranial ICA strongly indicates the presence of spontaneous ICA dissection.

Adult↗
PubMed2002

Areas of concern, quality of life and life satisfaction in patients with peripheral vascular disease.

OBJECTIVES: to explore the ways in which peripheral vascular disease subjectively affect patients and to relate these findings to validated measurements of quality of life (QOL) and life satisfaction. DESIGN: a cross-sectional study. SUBJECTS: eighty patients, with carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), intermittent claudication (IC) or critical limb ischaemia (CLI). METHODS: semi-structured interviews were used to explore the effect of the disease on the patients life situation. QOL was assessed by SF-36 and life satisfaction by LiSat-11. RESULTS: the SF36, LiSat-11 and our interview revealed two principal patterns: one for patients with CAS and AAA, and one for patients with IC and CLI. The interview revealed important areas affecting the vascular patient. Some of these areas: higher intellectual function, concern, sexual function, family concern and factors related to the operated areas were not covered by either the SF36 or the LiSat-11. CONCLUSIONS: for a full understanding of how peripheral vascular disease affects the individual, disease specific questions need to be added to generic QOL instruments and measurements of life satisfaction.

Adult↗
PubMed2002

Measuring the abdominal aorta with ultrasonography and computed tomography - difference and variability.

OBJECTIVES: The aim of this study was to estimate the agreement between ultrasonography (US) and computed tomography (CT) in the measurement of aortic diameter in subjects with and without abdominal aortic aneurysms (AAA). MATERIAL AND METHODS: Sixty-one subjects were investigated, 33 with a diameter >30mm and 28 with a diameter <30mm. Difference and variabily anteroposterior (AP) and transverse (TR) diameters were analysed. RESULTS: In non-aneurysmal aortas US gave larger AP: 2.8mm (95% CI 1.7-4.0) and TR: 3.8mm (2.3-5.3) diameter. In AAAs the mean diameter did not differ significantly. In non-aneurysmal aortas we expect 95% of differences to be <5.7mm in AP and <7.6mm in TR measurements. In aneurysmal aortas we expect 95% of differences to be <8.0mm in AP and <10.6mm in TR measurements. CONCLUSION: The difference and variability between US and CT varies depends on the diameter of the aorta and how it is measured. These differences have importance for clinical practice and for research.

Aged↗
PubMed2002

Endovascular approach to treating secondary arterioureteral fistula.

Two patients with the rare entity of arterio-ureteral fistula are presented. Both highlight the predisposing factors of radiation, major surgery in the region, history of vascular surgery and presence of double-J-stent. Both patients presented with the clinical sign of intermittent gross hematuria. Both patients were successfully treated by endovascular intervention using graft covered stent.

Aged↗
PubMed2001

Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review.

PURPOSE: Evidence-based medicine guidelines based on venographic end points recommend in-hospital prophylaxis with low-molecular-weight heparin (LMWH) in patients having elective hip surgery. Emerging data suggest that out-of-hospital use may offer additional protection; however, uncertainty remains about the risk-benefit ratio. To provide clinicians with a practical pathway for translating clinical research into practice, we systematically reviewed trials comparing extended out-of-hospital LMWH prophylaxis versus placebo. DATA SOURCES: Studies were identified by 1) searching PubMed, MEDLINE, and the Cochrane Library Database for reports published from January 1976 to May 2001; 2) reviewing references from retrieved articles; 3) scanning abstracts from conference proceedings; and 4) contacting pharmaceutical companies and investigators of the original reports. STUDY SELECTION: Randomized, controlled trials comparing extended out-of-hospital prophylaxis with LMWH versus placebo in patients having elective hip arthroplasty. DATA EXTRACTION: Two reviewers extracted data independently. Reviewers evaluated study quality by using a validated four-item instrument. DATA SYNTHESIS: Six of seven original articles met the defined inclusion criteria. The included studies were double-blind trials that used proper randomization procedures. Compared with placebo, extended out-of-hospital prophylaxis decreased the frequency of all episodes of deep venous thrombosis (placebo rate, 150 of 666 patients [22.5%]; relative risk, 0.41 [95% CI, 0.32 to 0.54; P < 0.001]), proximal venous thrombosis (placebo rate, 76 of 678 patients [11.2%]; relative risk, 0.31 [CI, 0.20 to 0.47; P < 0.001]), and symptomatic venous thromboembolism (placebo rate, 36 of 862 patients [4.2%]; relative risk, 0.36 [CI, 0.20 to 0.67; P = 0.001]). Major bleeding was rare, occurring in only one patient in the placebo group. CONCLUSIONS: Extended LMWH prophylaxis showed consistent effectiveness and safety in the trials (regardless of study variations in clinical practice and length of hospital stay) for venographic deep venous thrombosis and symptomatic venous thromboembolism. The aggregate findings support the need for extended out-of-hospital prophylaxis in patients undergoing hip arthroplasty surgery.

Aftercare↗
PubMed2001

[Research results should be freely accessible!-- Case reports demonstrate obstacles to contact with drug industry].

Recommendations on the use of medical technologies should be based on best available evidence. Publication bias due to delayed publication or non-publication of negative studies leads to inflated effect sizes in systematic reviews. We carried out a health technology assessment on prevention and treatment of venous thromboembolism, and in order to minimize publication bias asked the six pharmaceutical companies with antithrombotic drugs registered in Sweden to supply us with results from unpublished clinical trials. The answers were returned after 4 to 60 weeks, and with only one exception, after multiple reminders by telephone, fax and e-mail. No relevant unpublished studies were reported to us although we were made aware of two published studies that our literature search had not identified. One company did not mention a large negative unpublished clinical trial with their drug which has remained unpublished due to conflict between the company and the steering committee. We conclude that the companies did not contribute much and that the process was very time consuming with little result. As non-publication of trial results is unethical, we propose agreements between industry and researchers that all studies be prospectively registered and made publicly available.

Clinical Trials as Topic↗
PubMed2001

Timing of initial administration of low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: a systematic review.

BACKGROUND: Perioperative and postoperative venous thrombosis are common in patients undergoing elective hip surgery. Prophylactic regimens include subcutaneous low-molecular-weight heparin 12 hours or more before or after surgery and oral anticoagulants. Recent clinical trials suggest that low-molecular-weight heparin initiated in closer proximity to surgery is more effective than the present clinical practice. We performed a systematic review of the literature to assess the efficacy and safety of low-molecular-weight heparin administered at different times in relation to surgery vs oral anticoagulant prophylaxis. METHODS: Reviewers (A.F.M. and S.M.M.) identified studies by searching MEDLINE, reviewing references from retrieved articles, scanning abstracts from conference proceedings, and contacting investigators and pharmaceutical companies. Randomized trials comparing low-molecular-weight heparin administered at different times relative to surgery with oral anticoagulants in patients undergoing elective hip arthroplasty, evaluated using contrast phlebography, were selected. Two reviewers (A.F.M. and S.M.M.) extracted data independently. RESULTS: The literature review identified 4 randomized trials meeting predefined inclusion criteria. The results indicate that low-molecular-weight heparin initiated in close proximity to surgery resulted in absolute risk reductions of 11% to 13% for deep vein thrombosis, corresponding to relative risk reductions of 43% to 55% compared with oral anticoagulants. Low-molecular-weight heparin initiated 12 hours before surgery or 12 to 24 hours postoperatively was not more effective than oral anticoagulants. Low-molecular-weight heparin initiated postoperatively in close proximity to surgery at half the usual dose was not associated with a clinically or statistically significant increase in major bleeding rates (P =.16). CONCLUSIONS: The timing of initiating low-molecular-weight heparin significantly influences antithrombotic effectiveness. The practice of delayed initiation of low-molecular-weight heparin prophylaxis results in suboptimal antithrombotic effectiveness without a substantive safety advantage.

Administration, Oral↗
PubMed2001

Validation of in vivo noninvasive high-frequency ultrasonography of the arterial wall layers.

To validate estimates of the arterial wall thickness and its separate layers, 19 superficial (7 femoral and 12 cutaneous) arteries were transcutaneously sonographed in 13 anaesthetized pigs with a high-resolution equipment fitted with a 25 MHz frequency probe. Means of ultrasonographic estimates of each wall layer were compared with those obtained from microscopy of the respective arterial specimens taken after the pigs were sacrificed. For all vessels combined, Spearman-rank correlation tests between ultrasonography and histology estimates were significant for total arterial wall thickness (r(s) = 0.78; p =.0001) but not for the separate layers. For the cutaneous arteries, a significant correlation was found for total arterial wall thickness (r(s) = 0.69; p =.01) and media layer (r(s) = 0.76; p =.004). The method seems to give valid estimates of both total arterial wall and media thickness in superficial arteries, but to be less accurate for estimate the adventitia and intima layers.

Animals↗
PubMed2001

Coagulation and fibrinolysis in chronic venous insufficiency.

BACKGROUND: Varicose veins (VV) are common, but only some patients will develop chronic venous insufficiency (CVI) with skin changes or venous ulcer. The pathophysiology of venous ulcer development is complex, and may involve abnormalities in coagulation, fibrinolysis and proinflammatory cytokines. The purpose of this study was to correlate plasma markers within these systems and skin pathology. METHOD: A group of twenty consecutive patients with active or recent venous ulcer were matched for sex and age with further three groups of individuals i.e. controls and patients with VV with and without skin changes respectively. Blood samples were analysed for hemoglobin (HB), total platelet count (TPC), C-reactive protein (CRP), activated partial thromboplastin time (APTT), prothrombin complex (PT), fibrinogen, interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF alpha), D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), prothrombin fragments 1 and 2 (F1 + 2), and thrombin antithrombin III complex (TAT). RESULTS AND CONCLUSION: There was an increase of systemic levels of PAI-1 activity and tPA with progressive skin pathology in patients with CVI, and in the group with active ulcer there was an elevation of F1 + 2. Those findings could reflect a defect fibrinolysis, a thrombotic potential or a damaged endothelium.

Aged↗
PubMed2001

Low molecular weight heparin (enoxaparin) versus dextran in the prevention of early occlusion following arterial bypass surgery distal to the groin.

AIM: to compare the effect of perioperative dextran and low molecular weight heparin on early graft patency after femorodistal bypass surgery. DESIGN: prospective randomised multicentre study. PATIENTS AND METHODS: three hundred and fourteen patients were randomised to dextran 70 or the low molecular weight heparin enoxaparin during and after femorodistal bypass surgery. Patency was evaluated at days 1, 5-7, 30 and 90. RESULTS: there was no difference in patency at any time point between the two regimens, the crude 90 days patency being 88 and 83%, respectively. There were significantly more patients with heart failure in the dextran group (12.8 vs 0.7%), with other side effects being evenly distributed. CONCLUSION: dextran 70 and the low molecular weight heparin enoxaparin have the same effect on 90 days femorodistal graft patency, but care must be taken using the dextran to patients with a potential heart insufficiency.

Anticoagulants↗
PubMed2001

Literature review of surgical management of abdominal aortic aneurysm.

OBJECTIVES: To review the natural history and the outcome of surgical repair of aortic abdominal aneurysm (AAA). DESIGN: An English and Scandinavian language search of papers between 1985-1997. RESULTS: After review, 132 papers with 54 048 patients remained. The mean postoperative mortality (30 days or in-hospital) for elective repair was approximately 5% and for emergency operations 47% (range 27-69%), both with significant heterogeneity. Results did not improve over time. Increasing age, presence of renal failure and atherosclerotic cardiac disease were identified as pre-operative risk factors. AAA expansion averaged 0.2-0.4 cm per year for aneurysms smaller than 4 cm, 0.2-0.5 cm for aneurysms 4-5 cm and 0.3-0.7 cm for those larger than 5 cm. The rupture risk at four years was 2, 10 and 22% respectively. The overview revealed several methodological problems in the reported studies. CONCLUSIONS: The results can be used as the basis of quality assurance or in decision trees or other models. Better reporting standards are needed.

Adolescent↗
PubMed2001

Arterio-ureteral fistula--a systematic review.

OBJECTIVE: To review published reports on arterio-ureteral fistula. METHOD: Literature search. RESULTS: Eighty cases were identified. Primary fistulas were mainly seen in combination with aortoiliac aneurysmal disease. Secondary fistulas were seen after pelvic cancer surgery, often with radiation, fibrosis and ureteral stenting or after vascular surgery with synthetic grafting. The dominating symptom is massive haematuria, often with circulatory impairment. The clue to a rapid and correct diagnosis is a high degree of suspicion. Most frequently diagnosis has been obtained through angiography or pyelography. When there is a ureteral stent manipulation it will often provoke bleeding and lead to diagnosis. The fistula must be excluded and a vascular reconstruction made. Most frequently this has been obtained through occlusion of the fistula and an extra-anatomic reconstruction (femoro-femoral crossover). Recently stent-grafting has been successfully used but follow-up is short. CONCLUSION: Arterio-ureteral fistula is rare and should be suspected in patients with complicated pelvic surgery and massive haematuria, especially where rigid ureteral stents have been placed.

Adolescent↗
PubMed2001

Floating nonocclusive thrombus in the common femoral artery detected by duplex scanning after removal of the arterial catheter: a case report.

A 5-year-old girl is reported in whom duplex scanning showed a nonocclusive thrombus in the common femoral artery that was removed successfully by surgical intervention. Noninvasive examination with duplex scanning in patients with signs of acute arterial insufficiency during or after removal of femoral artery catheter is recommended.

Catheterization↗