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Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 181 records · Page 10Linked to original sources
PubMed1996

Patterns of atherosclerotic occlusive disease of lower leg and pedal arteries in hypertensive patients undergoing infrainguinal bypass procedures.

OBJECTIVE: To analyse the atherosclerotic involvement of lower leg and foot arteries in patients undergoing infrainguinal bypass grafting. SETTING: Department of Surgery, University Hospital. PATIENTS: Among 282 limbs (267 patients), fifty limbs belonged to hypertensive nondiabetics (Group A), 39 to hypertensive diabetics (Group B), 129 to normotensive nondiabetics (Group C) and 64 to normotensive diabetics (Group D). INTERVENTIONS: Femoropopliteal or femorodistal bypass procedures. MEASURES: Intraoperative postreconstruction serial angiography of the lower leg and foot arteries. RESULTS: Occlusion rate of two or three lower leg arteries was significantly higher among diabetics (Group B 77% and Group D 73%, respectively) compared to nondiabetics (Group A 56% and Group D 51%, respectively). It was similar in diabetic patients with or without hypertension. The incidence of having both foot arches (dorsal and plantar arch) intact was significantly higher in nondiabetic patients with hypertension (Group A). Only 5.8% of these patients demonstrated both deficient or occluded foot arches compared to 18% in Group B and 31% in Group C and 20% in Group D. CONCLUSION: Hypertension does not seem to contribute to the extent and severity of lower leg and foot vessel involvement in patients undergoing infrainguinal bypass surgery.

Aged↗
PubMed1996

Spontaneous internal carotid artery dissection. Review.

Spontaneous ICA dissection is an increasingly recognized cause of stroke especially in young adults. The most frequently reported site of involvement is the cervical part of the internal carotid artery (ICA). Although several primary arteriopathies have been related to the development of spontaneous ICA dissection the cause is not clear in most cases. The clinical picture varies from mild cerebral and/or cranial nerve dysfunction to a completed stroke. Angiography has been considered as gold standard in establishing diagnosis. Recently, duplex scanning has emerged as a powerful noninvasive diagnostic tool only in the initial assessment but in the serial follow-up of patients. Early diagnosis is essential as these lesions require anticoagulant treatment. Immediate heparinization is instituted after diagnosis, followed by oral anti-coagulation for at least six months. Surgical treatment is warranted in only few cases. Complete resolutions of the dissection is seen in at least 50% of cases. The risk of recurrent stroke remains low in patients discharged alive after spontaneous ICA dissection.

Adult↗
PubMed1995

Clinical relevance of the fibrinogen uptake test in patients undergoing elective general abdominal surgery--relation to major thromboembolism and mortality. Fragmin Multicentre Study Group.

Postoperative thromboembolic complications were evaluated in 2578 patients undergoing elective abdominal surgery, all receiving prophylaxis with low molecular weight heparin. A positive fibrinogen uptake test (FUT) developed in 217 patients (8.4%), while 37 patients (1.4%) had major thromboembolism (TE, defined as proximal deep vein thrombosis and/or pulmonary embolism, verified with phlebography, pulmonary scintigraphy or autopsy). In only 14% a positive FUT was associated with a major TE event. In 19% of the patients with major TE the FUT was negative. In multiple logistic regression the independent predictors for major TE were partially different from those for positive FUT. Thirty day mortality was 3.0%. There were significant associations between both positive FUT and major TE on one hand and mortality on the other (relative risks 2.4 and 5.8, respectively). FUT is not a good predictor of major TE. Both positive FUT and major TE indicate a significant risk of postoperative death.

Abdomen↗
PubMed1995

Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients.

The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 XaI units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter. The study was designed as a prospective, randomized, double-blind, multicentre trial. Some 66.4 per cent of patients were operated on for a malignant disorder. The primary endpoint was deep vein thrombosis (DVT) detected with the fibrinogen uptake test. Bleeding complications were recorded and classified. Analysis was made both on an intention to treat basis and in patients given correct prophylaxis (86.3 per cent). A total of 2097 patients were randomized and 27 excluded after randomization. A technically correct fibrinogen uptake test was obtained in 1957 patients. The incidence of DVT was significantly lower in patients given 5000 XaI units, this being true for both correct prophylaxis (6.8 versus 13.1 per cent, P < 0.001), on an intention to treat basis (6.6 versus 12.7 per cent, P < 0.001), and in patients with malignant disease (8.5 versus 14.9 per cent, P < 0.001). Sixty-seven patients (3.2 per cent) died within 30 days with no difference between the groups. There were two cases of fatal pulmonary embolism. The frequency of bleeding complications in the whole series was higher in patients randomized to 5000 XaI units (4.7 versus 2.7 per cent, P = 0.02), although this was not the case in those operated on for malignant disease (4.6 versus 3.6 per cent, P not significant). Dalteparin in the dose of 5000 XaI units started in the evening before surgery has a good thromboprophylactic effect in high-risk general surgery at the cost of a small bleeding risk. In patients with malignant disease there was no increased risk of bleeding. The overall frequency of fatal pulmonary embolism with dalteparin is extremely low, even in this high-risk group of patients.

Adult↗
PubMed1995

Effect of isovolemic hemodilution with dextran and albumin on thrombus formation in artificial vessel grafts inserted into the abdominal aorta of the rabbit.

The effects of isovolemic hemodilution with dextran-70 and albumin on thrombus formation in artificial arterial grafts were investigated. A polytetrafluoroethylene graft (PTFE, length 13 mm, inner diameter 3 mm) was inserted into the abdominal aorta of rabbits. Three groups of animals were studied; 1) animals receiving isovolemic hemodilution with dextran-70 (10 ml/kg body weight), 2) animals receiving isovolemic hemodilution with albumin (10 ml/kg body weight), and 3) nonhemodiluted controls. The blood flow increased by about 70% and 60% after the hemodilution with dextran and albumin, respectively, and remained high in the hemodiluted animals, after insertion of the graft. After 2 days, the vessel graft was removed and weighed. The thrombus mass was separately weighed. The results suggest that isovolemic hemodilution with both albumin and dextran is associated with a marked increase in blood flow in the rabbit. Hemodilution with dextran also reduced the amount of thrombus formation on the inner wall of the graft.

Albumins↗
PubMed1995

Femoropopliteal-crural graft patency is improved by an intensive surveillance program: a prospective randomized study.

PURPOSE: The purpose of this study was to evaluate whether intensive surveillance compared with routine follow-up examinations improves femoropopliteal/crural graft patency. METHODS: After operation the patients were randomized to intensive (n = 79) or routine surveillance (n = 77). The groups were matched with regard to sex, diabetes, indication for surgical procedure, surgical procedure, and graft material. Intensive surveillance was clinical examination, ankle/brachial index measurements, and duplex scans 1, 3, 6, 9, 12, 15, 18, 21, 24, and 36 months after operation. Routine surveillance was clinical examination and ankle/brachial index measurements without duplex scanning 1, 12, 24, and 36 months after operation. Grafts with a decrease in ankle/brachial index of more than 0.15 compared with the initial postoperative ankle/brachial index or a duplex scan showing a graft or anastomotic stenosis of more than 50% underwent angiography and if necessary, a revision or repeat procedure. Occluded grafts were reopened with thrombectomy or thrombolysis or were replaced with a new graft. RESULTS: Assisted primary cumulative vein graft patency in the intensive group (n = 56) compared with that in the routine surveillance group (n = 50) after 3 years was 78% versus 53% (chi square analysis, 4.51; one degree of freedom; p < 0.05). Secondary patency was 82% versus 56% (chi square analysis, 5.62; one degree of freedom; p < 0.05). Assisted primary cumulative e-polytetrafluoroethylene and composite graft patency after 1 year in the intensive group (n = 23) compared with that of the routine surveillance group (n = 20) was 57% vs 50% (chi square analysis, 2.17; one degree of freedom; p > 0.1). Secondary patency was 67% vs 54% (chi square analysis, 1.85; one degree of freedom; p > 0.1). Revisions were made on 14 patent and 10 thrombosed grafts in the intensive group and on four patent and 15 thrombosed grafts in the routine surveillance group. All except eight were made during the first postoperative year. CONCLUSIONS: Intensive surveillance identified failing vein grafts leading to a significantly higher cumulative assisted primary and secondary patency compared with cumulative assisted primary and secondary patency after routine follow-up examination. The patency of e-polytetrafluoroethylene and composite grafts was not influenced by intensive surveillance.

Aged↗
PubMed1995

When is urgent revascularization unnecessary for acute lower limb ischaemia?

OBJECTIVES: To predict the risk of gangrene by the use of simple clinical parameters available on admission. DESIGN: Retrospective comparison using logistic regression and chi2 analyses of prospectively registered data from two patients series. METHODS: One group of patients with acute lower limb ischaemia, (n = 61) was managed by selective initial non-operative treatment (NO) in a university hospital. The other group (n = 173) contained patients managed by early revascularisation in a multicentre (MC) study from 10 university, county and district hospitals. Gangrene and death within one month were recorded. RESULTS: 57% of patients in the NO group were initially managed by intravenous heparin followed by surgery when necessary. Impaired motor function and skin cyanosis in the ischaemic limb predicted gangrene. Patients without this combination were low risk (LR) patients and constituted 62% (NO) and 67% (MC). Non-operatively managed LR patients did not develop gangrene, whereas 14% of those undergoing early revascularisation in the two series did (p < 0.05). CONCLUSIONS: The results suggest that patients without motor disturbance and cyanosis are at low risk of gangrene and may benefit from initial non-operative treatment, irrespective of the presumed aetiology.

Acute Disease↗
PubMed1995

Pharmacological prophylaxis against postoperative graft occlusion after peripheral vascular surgery: a world-wide survey.

OBJECTIVES: To define current practice regarding the use of pharmacological prophylaxis to prevent postoperative graft occlusion. DESIGN: Prospective open questionnaire. MATERIALS AND METHODS: Questionnaires regarding this subject were sent to vascular surgeons throughout the world to analyse current practice. RESULTS: 651 questionnaires were returned with a response rate of 62% and form the basis for this report. Data from 100,334 vascular reconstructions were reported in this survey. Prophylaxis against postoperative graft occlusions was common. Treatment periods were usually greater than 1 year. Among carotid surgery patients, 82% received prophylaxis, consisting mainly of low-dose acetysalicylic acid (ASA). In Mid-Europe the use of oral anticoagulation was more common than in other regions (p < 0.001). Among aneurysm surgery patients, 38% received prophylaxis. For infrainguinal bypass, ASA in low dose was the most commonly used agent worldwide. However, oral anticoagulation was more frequent in Mid-Europe, in contrast to South America where the combination of ASA and dipyridamole was most common. Considerable geographical differences regarding patient selection, the frequency of specific procedures and operative techniques existed. CONCLUSIONS: Important world-wide differences exist regarding prophylaxis for postoperative graft occlusion.

Anticoagulants↗
PubMed1995

Effect of dextran and enoxaparin on early ePTFE graft thrombogenicity in sheep.

OBJECTIVES: To evaluate the effect of low molecular weight heparin (LMWH), dextran 70 and their combination on platelet adhesion and fibrinogen uptake in ePTFE grafts in an experimental sheep model. DESIGN: Prospective open study. SETTING: Animal Laboratory of a University Hospital. MATERIALS: Early thrombogenicity of ePTFE grafts was studied after interposition in the two common carotid arteries of 40 adult sheep. The animals received one of four different treatment regimens in a double blind randomised way: enoxaparin and polygeline, saline and dextran 70, enoxaparin and dextran 70 or saline and polygeline (control). The substances were administered i.v. with a total dose of 73 antifactor-Xa U/kg for enoxaparin and 1.0 g/kg for dextran 70. Polygeline and saline were used as placebo substances in equivalent volumes. On one side (random allocation) the carotid blood flow was restricted to 25 ml/min, on the other side it was left unrestricted. CHIEF OUTCOME MEASURES: The following variables were studied: 1) fibrinogen uptake; 2) platelet uptake; 3) early graft patency; 4) blood flow in patient grafts; 5) visible presence of graft thrombus; 6) thrombus weight. MAIN RESULTS: The results verified the importance of adequate blood flow as only 30% of grafts with restricted blood flow in the control group were patent compared with 80% of those with unrestricted blood flow (p = 0.038). Dextran 70, enoxaparin and the combination of the two increased early graft patency (p < 0.05) and reduced thrombus weights (p < 0.05) in grafts with restricted blood flow. The relative number of grafts with thrombus free surface was increased in the unrestricted blood flow situation. CONCLUSIONS: Dextran 70 and enoxaparin appeared to be equally effective in decreasing fibrinogen and platelet uptake in the grafts. Their combination was not significantly more effective although there was a favourable trend.

Animals↗
PubMed1995

Cranial nerve injuries after carotid artery surgery. A prospective study of 663 operations.

OBJECTIVE: To establish the incidence of cranial nerve injuries caused by carotid artery surgery. METHODS: During the years 1982 to 1992, 689 carotid artery operations were performed at Malmö General Hospital. Of these 656 were pre- and postoperatively examined at the Department of Phoniatrics concerning the function of the cranial nerves IX, X, and XII. RESULTS: There was injury to one or more of the examined nerves after 75 operations (11.4%). In 70 (10.7%) operations the hypoglossal nerve was injured, in eight (1.2%) the recurrent laryngeal nerve, in two (0.3%) the glossopharyngeal nerve and in two (0.3%) the superior laryngeal nerve. Seven patients complained of postoperative hoarseness, but had no injuries. One hypoglossal and one recurrent nerve injury was permanent. Nerve injury was more frequent in operations performed with a shunt (p = 0.05), with patch closure (p = 0.01) and by a junior surgeon (p = 0.05). CONCLUSION: In a prospective series, the incidence of cranial nerve injuries after carotid surgery was significant but the vast majority were reversible.

Adult↗
PubMed1995

Reduction of requirement for leg vascular surgery during long-term treatment of claudicant patients with ticlopidine: results from the Swedish Ticlopidine Multicentre Study (STIMS).

OBJECTIVE: To study the effect of long-term treatment of the platelet inhibitor ticlopidine as secondary prevention against the need of vascular surgery in patients with intermittent claudication. DESIGN: The Swedish Ticlopidine Multicentre Study (STIMS), was conducted in six medical and surgical clinics of university hospitals in Sweden. METHODS: 687 claudicants were randomised to ticlopidine 250 mg bd or placebo and vascular surgery events were recorded prospectively over a 7-year period. Cox proportional hazards models of risk for leg vascular surgery were constructed using drug treatment and 11 putative risk factors for vascular disease as covariates. Surgical event-free survivals were compared by Kaplan-Meier analysis. RESULTS: The overall rate of first operations was 2.4% per annum. More than half of these operations were in the aortoiliac region. One-quarter of patients operated during the period required further operations but amputation was rare. Ticlopidine treatment reduced the need for vascular reconstructive surgery by about half, both in intention-to-treat and on-treatment analyses (unadjusted relative risks 0.486, 95% CI 0.317-0.745; p < 0.001; 0.493, 95% CI 0.290-0.841: p < 0.01, respectively). In Cox model analysis only male sex was confirmed as a risk factor for surgery. Previous peripheral arterial surgery was the strongest predictor of the need for surgery. None of the risk factors examined interacted statistically with the effect of treatment with ticlopidine. CONCLUSION: In patients with intermittent claudication it seems possible to prevent the need for future vascular surgery by the use of platelet inhibition with ticlopidine.

Female↗
PubMed1995

The effect of postocclusion reactive hyperaemia, papaverine and nifedipine on duplex derived haemodynamic parameters of infrainguinal bypass grafts.

OBJECTIVES: The aim of the present study was to analyse the effects of various vasodilating stimuli on postoperative infrainguinal graft haemodynamics. DESIGN: Duplex derived haemodynamic parameters of infrainguinal bypass grafts were measured at rest and after postocclusion reactive hyperaemia, intraarterial papaverine (40 mgm) injection and peroral nifedipine (10 mg) administration. SETTING: Department of Surgery, University Hospital. MATERIALS: Twenty-nine patients with infrainguinal bypass grafts were studied by Duplex scanner after a median of 25 months postoperatively. CHIEF OUTCOME MEASURES: Peak systolic velocity (PSV), mean velocity (MV) and volume flow (VF) were measured at rest and after various stimuli. MAIN RESULTS: VF at rest increased from 125 +/- 16 ml/min (mean +/- S.E.M.) to 271 +/- 26 ml/min after papaverine administration and to 205 +/- 19 ml/min during reactive hyperaemia (p < 0.001). PSV, MV and VF increased significantly during postocclusion reactive hyperaemia and papaverine injection. After nifedipine administration VF increased to 154 +/- 21 ml/min after 30 min (p < 0.001) and there was a significant increase in MV (p < 0.05). CONCLUSIONS: Duplex derived flow measurement of infrainguinal bypass grafts can evaluate graft and limb haemodynamics in the postoperative period. Pharmacological manipulations, such as vasodilation, can influence the physiological runoff with subsequent increase in volume flow through the graft.

Aged↗